Lateral hindfoot impingement MRI Ankle

MRI ANKLE

MRI coronal STIR section of ankle joint shows degenerative subchondral bone marrow oedema involving articular surface of lateral malleolus of fibula, lateral process of talus and calcaneum, loss of joint space, degenerative sub chondral cystic geodes in the lateral process of talus at subtalar joint without joint effusion.

The bone marrow edema in calcaneum is confined to the subjacent articulating surface and characteristically not present all along the cortex around the margins of the sinus tarsi on sagittal STIR. Possibility of lateral hindfoot impingement suggested.

If bone marrow edema in calcaneum is present all along the cortex around the margins of the sinus tarsi, this would not be characteristic and would instead suggest the different diagnosis, that of sinus tarsi syndrome.

There is associated diffuse thickening of anterior talo fibular ligament.

Osseous findings of lateral hindfoot impingement include degenerative changes like subchondral sclerosis, subcortical bone marrow edema at specific locations at the talus, calcaneus and or fibula, sub chondral cystic geodes in advanced cases.

The incidence of calcaneofibular impingement is somewhat lower than talocalcaneal impingement, with calcaneofibular impingement present almost exclusively in individuals shows changes of talocalcaneal impingement, suggesting that the talocalcaneal osseous changes occur before the calcaneofibular changes.

Dural ectasia spine MRI

 

Sagittal MR images of spine showing multiple contiguous widening of CSF space posterior to the cord in thoracolumbar region, associated posterior scalloping of the vertebral bodies, widening of caliber of the bony spinal canal, hypo plastic posterior elements. 

Axial T2 images, STIR coronal images showing multiple lateral meningoceles in thoracolumbar region with enlarged neural foramen.

Spinal cord displaced anteriorly, flattened, compressed against anterior confines of anterior bony spinal canal.

Imaging diagnosis: dural ectasia.

Dural ectasia is widening of the dural sac, associated with herniation of nerve root sleeves out of foramina. Scalloping of the posterior vertebral body, thinning of cortex of pedicles and laminae, widening of neural foramina expected to prolonged pressure effect from the dural sac containing CSF.

Dural ectasia is very well-known with  Marfan syndrome however can also be associated with other inherited connective tissue disorders, including Ehlers-Danlos syndrome and Loeys-Dietz syndrome, type 1 neurofibromatosis, ankylosing spondylitis, Lehman syndrome.

Dural ectasia can also be associated with trauma, scoliosis.

May be asymptomatic, may present with back pain, headaches, radicular pain, leg weakness or urinary incontinence.

Little finger FDP tendon, A2 pulley injury

 MRI LITTLE FINGER

SAGITTAL T2 5TH FINGER

SAGITTAL T2 5TH FINGER

AXIAL T2 A2 PULLEY AT MID PORTION OF PROXIMAL PHALYNX 5TH FINGER

This MRI study of litter finger shows: 

Full-thickness flexor digitorum profundus, FDP tendon tear, Zone II injury. 

There is associated retraction of the proximal end, spring coiled, the torn end of proximal stump is at the level of metacarpo phalangeal joint, with a gap of 36 mm. Length of the distal stump measuring approximately 20 mm from its insertion on to the base of distal phalanx. Quality of both torn ends of the tendon is good, sharp without abnormal fraying or degeneration.

Associated A2 pulley injury at the level of midportion of proximal phalanx with approximately 4 mm bowstringing of FDS. 

A3 pulley intact. 

No associated bony avulsion.

No associated joint subluxation.

No associated volar plate injury.

No associated collateral ligaments tear.