The wrist and hand have complex anatomy with small bones and supporting soft tissue structures, which limits the diagnostic yield for radiologic assessment. Knowledge of anatomy and different clinical entities is key to the radiologic diagnosis. Some of the essential anatomic and clinical topics in radiologic interpretation include knowledge of the topographic tendon anatomy of wrist and hand, the intrinsic and extrinsic carpal ligaments, the thumb ligaments, thumb carpometacarpal ligaments, the triangular fibrocartilage complex, the extensor mechanism, and the flexor tendons and pulleys. In this chapter, common traumatic injuries affecting the wrist and hand are reviewed.

Shoulder pain accounts for 16% of the musculoskeletal complaints and represents an important cause of absenteeism of work. Abnormalities of the rotator cuff, including tears, are frequently seen on imaging studies. Unfortunately, asymptomatic tears are frequent, up to 60% in patients older than 60 years old; therefore clinical correlation is essential. New anatomical concepts and new surgical techniques have evolved within the entire spectrum of lesions. It is essential to be aware of the information that is important for the decision-making as this information should stand out in our reports. In this course we will therefore review the different rotator cuff tears and its differential diagnosis.

Glenohumeral instability is the inability to keep the humeral head centered in the glenoid fossa. Glenohumeral instability can be classified according to etiology and direction of instability. The glenoid labrum, the glenohumeral ligaments, and the bony structures contribute to the stability glenohumeral joint and need to be addressed with imaging. One of the difficulties with accurately diagnosing labral tears on MR imaging is the normal labral variants, which can sometimes appear similar to tears. The location and extent of a Hill-Sachs lesion and glenoid rim defects need to be related to recognize engaging Hill-Sachs lesions or off-track situations. There are several types of labral tears that are not associated with a prior dislocation. SLAP tears are one of the more common tears of the labrum and can sometimes be difficult to distinguish from a normal variant superior sublabral recess. Labral tears in overhead thrower occur in the posterosuperior labrum, adjacent to the posterior rotator cuff tears in these athletes. Tears in the posterosuperior labrum are also associated with spinoglenoid notch paralabral cysts, which can be painful and cause external rotation weakness.

The ankle and foot are anatomically complex areas with a broad spectrum of intra- and extra-articular pathologies. This chapter reviews basic anatomical features and gives an overview on common pathologic conditions with an emphasis on trauma/sports injuries and MR imaging.

Imaging has a crucial role in detecting internal derangements of the knee, and knowledge of pathologic conditions has increased. Imaging aspects of meniscal, ligament, tendinous, and chondral lesions will be discussed in this chapter.

Conventional radiographs and CT are primary investigations in spinal trauma. However MRI is the primary technique in the assessment of degenerative and inflammatory disorders. There are occasions when conventional radiographs, CT and bone scintigraphy assist in the diagnosis of degenerative and inflammatory disorders. A detailed understanding of anatomy and spine dynamic function is essential in the interpretation of imaging. Degenerative disorders including disc disease sometimes result in neural compression, facet joint and costovertebral arthropathy which is also potentially associated with spinal stenosis and neural compression. Scheuermann described a disorder with template irregularity that mimics degenerative disorders but is a genetic condition. Pars interarticularis stress fractures were once thought to be congenital in origin but are now regarded as stress injuries occurring in adolescence potentially leading to lifelong spondylolisthesis. Inflammatory joint disease is not just ankylosing spondylitis. There are a range of disorders, and the reporting practitioner must understand and appreciate the symptoms and signs on images. The early diagnosis of inflammatory arthropathy especially ankylosing spondylitis is essential in the effective management of the disease. Imaging is a major component of an accurate and effective diagnosis.

The perceived value of the radiologist to the healthcare team hinges on the accuracy of image interpretation and the quality, clarity, and consistency of the associated report. A thorough understanding of what clinicians want to know from imaging of soft tissue, bone, and bone marrow tumors allows the radiologist to better analyze and communicate the relevant findings using a common multidisciplinary language. Inclusion in the report of a detailed patient history relative to the tumor is also important in that it indicates to the clinician and the patient a clear engagement in the patient’s care and an insight into the desired imaging objectives. With these tenets in mind, this review highlights what clinicians want to know from imaging for soft tissue, bone, and bone marrow tumors.

Worldwide, more than 50 million children and adolescents participate in organized athletic programs annually. Despite the numerous health and well-being benefits, this widespread involvement also leads to acute and overuse injuries that account for millions of medical visits each year. Musculoskeletal injury in childhood may lead to growth disturbance and lifelong disability. Imaging plays a critical role in the diagnosis and management of these injuries. While radiography is sufficient for most long bone fractures, MRI is often necessary for optimal evaluation of injuries involving the radiolucent growth mechanism and articular structures. The following review will discuss the imaging features associated with many sports-related injuries unique to the pediatric musculoskeleton, specifically the lower extremity.