Seminars in Musculoskeletal Radiology最新文献

This case-based review explores the biomechanical foundations of the wrist by integrating advanced imaging findings with core anatomical and functional principles. We analyze six representative scenarios: distal radioulnar joint instability, ulnocarpal impaction, unstable triangular fibrocartilage complex tear, scapholunate ligament injury, posttraumatic ulnar translocation of the carpus, and scaphotrapeziotrapezoid osteoarthritis. The cases reviewed here illustrate how static and dynamic stabilizers preserve carpal congruence and load transmission. We highlight the roles of the triangular fibrocartilage complex, the distal interosseous membrane, and the intrinsic and extrinsic ligament systems, along with the kinematic interplay between carpal rows and sensorimotor control mechanisms. We emphasize the value of magnetic resonance imaging, magnetic resonance arthrography, and wrist arthroscopy as essential tools for detecting instability and planning treatment. By applying biomechanical principles to imaging interpretation, we can enhance lesion pattern recognition, support informed surgical decision making, and foster a more effective multidisciplinary approach to wrist pathology.

The distal radioulnar joint is essential for forearm rotation and wrist stability. Instability of the distal radioulnar joint, often resulting from trauma, ligamentous injury, or degeneration, can lead to pain, functional impairment, and progressive joint damage. Accurate diagnosis relies on a thorough imaging assessment due to the complex joint anatomy, especially the triangular fibrocartilage complex.Standard radiographs are useful to evaluate bone alignment but have limited soft tissue sensitivity. Ultrasound provides dynamic real-time assessment of superficial structures, although it is operator dependent. Computed tomography offers excellent spatial resolution for bony abnormalities and joint congruity, with a static and pseudo-dynamic approach, considered the gold standard.Magnetic resonance imaging is the reference standard for soft tissue evaluation, particularly the triangular fibrocartilage complex and surrounding ligaments. Emerging dynamic imaging techniques, including real-time magnetic resonance imaging and four-dimensional computed tomography, allow visualization of joint kinematics and detection of subtle instabilities not seen on static images. This review outlines the role of each modality in assessing distal radioulnar joint instability.

The general term collagenosis covers a group of connective tissue diseases triggered by systemic autoimmune processes and as yet unknown trigger mechanisms. Systemic sclerosis is one of the five types of collagenosis. Of the systemic rheumatic diseases, it has the highest mortality rate, partly due to the historical lack of disease-modifying therapies. Early diagnosis of systemic sclerosis can be challenging if the typical symptoms and diagnostic or classification criteria are not yet evident. However, given the disease's often heterogeneous course, early diagnosis and treatment are crucial for prognosis and to protect against progression involving the internal organs. Because reliable and prognostically valid biomarkers are generally lacking, deciding whether or not to pursue aggressive treatment in the early stages of the disease remains problematic. This article discusses the potential benefits of imaging techniques such as magnetic resonance imaging and pharmacoangiography for the early diagnosis of systemic sclerosis.

Crystal arthropathies of the hand encompass a wide spectrum of disorders characterized by the deposition of various crystals within joints and soft tissues, often leading to inflammatory and degenerative changes. Due to their ability to mimic other rheumatic diseases, accurate diagnosis is challenging and relies heavily on imaging. This review highlights the pathophysiologic features and typical manifestations of key crystal arthropathies-calcium pyrophosphate crystal deposition, gout, hydroxyapatite deposition disease, oxalosis, amyloidosis, and rare mimickers such as ochronosis-focusing on their radiologic appearances. Emphasis is placed on the strengths and limitations of different imaging modalities, particularly radiography, ultrasound, computed tomography, magnetic resonance imaging, and dual-energy computed tomography, in detecting both crystal deposits and associated inflammatory activity. Understanding these imaging patterns is essential for an appropriate differential diagnosis and clinical management.

This history page in the series "Leaders in Musculoskeletal Radiology" is dedicated to the memory and achievements of the German radiologist Alban Köhler (1874-1947), whose name is immortalized in several eponymous conditions, including Köhler's disease I and II. His pioneering work in skeletal imaging and his meticulous approach to radiographic analysis have left an enduring legacy in the field of musculoskeletal radiology.

Flexor tendon pathologies of the hand are frequently encountered in musculoskeletal radiology and require a precise diagnosis and treatment due to the complexity of the anatomy. Typical conditions are acute traumatic injuries such as tendon and/or pulley rupture as well as open lacerations. In addition, there is a wide range of infectious diseases, chronic overuse conditions, as well as degenerative, neoplastic, and systemic/rheumatic tendon disorders. Accurate characterization of these lesions with ultrasound for basic diagnostics and magnetic resonance imaging for further clarification is crucial for optimal therapy management and prognosis. Following a patient presentation, this article reviews the anatomy and diagnostic imaging features of the most common flexor tendon pathologies.

The recently introduced CUP classification of the triangular fibrocartilage complex divides the lesions into central (C), ulnar (U), and peripheral (P). The periphery of the triangular fibrocartilage complex consists of the meniscus homologue, the ulnocarpal joint capsule including the extensor carpi ulnaris tendon sheath, and the ulnotriquetral and ulnolunate ligaments. Peripheral triangular fibrocartilage complex lesions can occur in isolation or in combination with injuries of the ulnar insertions and/or the articular disk. Most commonly the meniscus homologue and dorsal capsule are affected. Magnetic resonance imaging and computed tomography/magnetic arthrography are used to assess peripheral lesions. The arthroscopic assessment of peripheral triangular fibrocartilage complex lesions is limited. To date, data on the clinical relevance of the radiologic reporting of peripheral lesions are lacking. This pictorial review illustrates typical peripheral lesions of the triangular fibrocartilage complex according to the CUP classification.

Disorders of the extensor mechanism of the wrist and hand are frequently encountered in clinical practice and observed more commonly than pathologies affecting the flexor system. When unrecognized or inadequately treated, these conditions may lead to substantial functional impairment and suboptimal clinical outcomes. Extensor tendon pathologies encompass a wide range of etiologies, such as repetitive overuse, acute trauma, inflammatory arthropathies, and degenerative tendinopathies. Accurate diagnosis depends on a thorough clinical evaluation, supported by high-resolution imaging. Ultrasound and magnetic resonance imaging are particularly useful for assessing tendon structure, surrounding soft tissues, and dynamic abnormalities. This review offers an updated overview of extensor tendon disorders of the wrist and fingers, focusing on their underlying causes and key imaging findings on magnetic resonance imaging and ultrasound to support an accurate and efficient diagnosis by radiologists.

A wide spectrum of conditions can trigger signal alterations in the lunate bone. From vascular complications such as Kienböck's disease to axial microtrauma in ulnocarpal impaction syndrome, the lunate signal is an essential indicator of carpal health. Many of the pathologies described in this review rely on magnetic resonance imaging for analysis; however combined assessment of patient history, clinical symptoms, and imaging is often the only way to find the correct diagnosis. Standard radiography serves as the first-line modality for diagnostic assessment in most patients, but morphological analyses are more precise when based on high-resolution computed tomography imaging. Because gadolinium enhancement (not edema) is the deciding factor in the vitality assessment of the lunate, the imaging work-up of suspected osteonecrosis should include intravenous administration of contrast agent to discern viable tissue and so-called repair zones from entirely necrotic bone.

Imaging, an essential diagnostic tool found ubiquitously in modern clinical practice, is particularly useful for evaluating musculoskeletal (MSK) pathology. However, technical errors in imaging and imaging artifacts are pitfalls that frequently diminish image quality and may lead to misinterpretation of radiologic studies by radiologists and clinicians. This review describes the causes and imaging appearances of the more common and important MSK imaging technical errors and artifacts in radiography, ultrasound, computed tomography, magnetic resonance imaging, and MSK intervention that may potentially lead to erroneous interpretation. Where applicable, strategies to mitigate the impact of these pitfalls are also discussed.