Venous Malformation in the Gastrocnemius Muscle.

A 35-year-old woman was referred to physical therapy by her primary care physician for right calf pain with gradual onset over 1 year. Following examination, the patient underwent 2 months of treatment; given limited progress, the patient was referred to an orthopaedist. Radiographs revealed several phleboliths and magnetic resonance imaging revealed an intramuscular vascular mass within the lateral gastrocnemius. J Orthop Sports Phys Ther 2020;50(2):110. doi:10.2519/jospt.2020.9091.

A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy.

The purpose of this study is to quantify the lesser trochanteric version and determine the angle and the relationship between lesser trochanter and femoral neck version. Investigate the influence of the lesser trochanter version in the width of ischiofemoral space. Two hundred and fifty asymptomatic hips were evaluated with axial magnetic resonance image. The lesser trochanter version was calculated. The difference between the femoral neck version and the lesser trochanter version formed the angle between each structure. The width of ischiofemoral space was measured and its relationship with the lesser trochanter version was determined. The mean lesser trochanter version was -24° ± 11.5° (range, - 54° to + 17°) with a coefficient variation of 47.45%. The mean femoral neck version measured 14.0° ± 10.8° (range, -16° to 50°), with a coefficient variation of 81.32%. The lesser trochanter/femora neck angle was 38.4° ± 9.6° (range, 8° to 67°), coefficient variation of 30%, with a moderate correlation between the structures (r = 0.63, P < 0.01). The mean ischiofemoral space was 22.9.0 ± 7.0 mm (range, 10.3 to 55 mm), and a weak correlation was found between ischiofemoral space and lesser trochanteric version (r = -0.16, P < 0.05). The lesser trochanteric version showed a high variation with a moderate relationship with the femoral neck version. The lesser trochanteric version does not influence the width of the ischiofemoral space.

Flexor tendon pulley injury in a bowler.

Closed traumatic flexor injuries of the hand involving the pulley mechanism are a relatively common injury seen in rock climbers but are very rare in nonclimbers, including bowlers. The injury was first described in 1990. Since then, several studies have shed more light on the diagnostic and therapeutic considerations. Early diagnosis of pulley injuries is crucial since delayed diagnosis can lead to limited range of motion, particularly at the proximal interphalangeal joint. Flexion contractures at the proximal interphalangeal joint have also been cited in the literature. We discuss a case of pulley injury in a bowler and briefly review the anatomy of the pulley architecture, mechanism of injury, imaging manifestations, and clinical management of this injury.

MRI of spring ligament tears.

OBJECTIVE: Surgical repair of the spring ligament is becoming recognized as an important management component of adult-acquired flatfoot, yet little literature exists on the MRI appearance of spring ligament abnormalities. In this article, we describe the MRI appearance of surgically proven spring ligament tears. CONCLUSION: MRI findings present in surgically proven spring ligament tears include an abnormal spring ligament caliber, signal intensity, waviness, a full-thickness gap, and posterior tibial tendonopathy. The finding unique to cases with surgically proven tears is a full-thickness gap in the ligament, seen in 79% of the cases in our series. When multiple abnormalities are seen in the spring ligament in conjunction with a full-thickness gap, the diagnosis of a tear can be made with confidence.

Adult tibial intercondylar eminence fracture: evaluation with MR imaging.

Tibial intercondylar eminence (TIE) fractures are well described in the pediatric orthopedic literature. Adult TIEs are much less common, and limited literature exists on the subject. Adult knee hyperextension injuries commonly result in anterior cruciate ligament (ACL) injury; however, with significant trauma, a TIE enters the differential diagnosis. Identification and classification of TIE fractures typically has been provided by radiography. The incidence of concomitant injuries with magnetic resonance (MR) imaging in patients with adult TIE fractures has not been determined. We present a case of an adult type III TIE fracture seen on radiography that only with further MR imaging revealed a concomitant lateral tibial plateau fracture. Utilization of MR imaging altered the surgeon's course of treatment and postoperative care. Radiographic and MR images and a review of the literature are provided.