LOCALIZED NODULAR SYNOVITIS OF THE KNEE: A REPORT OF TWO CASES WITH ABNORMAL ARTHROGRAMS*

Size: px
Start display at page:

Download "LOCALIZED NODULAR SYNOVITIS OF THE KNEE: A REPORT OF TWO CASES WITH ABNORMAL ARTHROGRAMS*"

Transcription

1 MARcH, i6 LOCALIZED NODULAR SYNOVITIS OF THE KNEE: A REPORT OF TWO CASES WITH ABNORMAL ARTHROGRAMS* ABSTRACT: By THOMAS G. GOERGEN, M.D.,t DONALD RESNICK, M.D.,t and GEM NIWAYAMA, M.D4 SAN DiEGO, CALIFORNIA The anthrognaphic appearance in two cases of localized PVS of the knee involving the region of the infrapatellar fat pad is reported. Lesions in this area may present with confusing symptomatology, and the true abnormality may be overlooked in a search for a meniscal lesion. The anthrogmaphic picture is non-specific and a number of entities must be considered. P IGMENTED villonodular synovitis (PVS) is a benign proliferative disease of synovial tissue which may be either diffuse on localized and nodular. Preoperative diagnosis by double contrast arthnogmaphy has been reported in the diffuse form of the disease,9 but there are no reports using arthnography for diagnosis of the less common nodular form. Recently, we have seen two cases of nodular PVS of the knee with arthrographic abnormalities localized to the region of the infrapatellar fat pad. A paucity of material describing the normal arthrographic appearance of this region led to further investigation. REPORT OF CASES CASE I. A 25 year old man complained of a popping sensation in his right knee, present for five months, with intermittent locking. Clinical examination revealed audible and palpable clicking with flexion and with forceable extension in internal rotation. Arthrography showed normal menisci, but a prominence was noted in the region of the infrapatellar fat pad (Fig. IA). Because of clinical findings, the lateral meniscus was removed, but the clicking persisted. Further in traoperative investigation showed a large fibrous mass, which appeared to arise from the infrapatellar fat pad which was then excised. On gross examination a firm, wellcircumscribed mass measuring 2.5X2X2 cm was attached to adjacent adipose tissue (Fig. IB). Histologic study revealed fibrous proliferation with many histiocytes, occasional foamy histiocytes, and multinucleated giant cells, many containing hemosiderin pigment (Fig. i, CandD). CASE II. A I 5 year old girl complained of right knee pain and recurrent buckling following a bicycle accident one year prior to examination. The clinical interpretation was a torn medial meniscus, but an arthrogram revealed normal menisci. Retrospectively, a prominent intraarticular bulge in the region of the infrapatellar fat pad was present on the overhead lateral view (Fig. 2A). A few weeks later she twisted her knee which locked in 10#{176} of flexion. At surgery, a large pedunculated mass measuring 4 X 2 X I cm extended into the intercondylar notch from the region of the infrapatellar fat pad. It was partially attached to the ligamentum mucosum. There was surrounding synovial inflammation. Histologic examination revealed many spindle shaped cells with formation of collagen fibers. Hemosiderin-laden m acrophages with multinucleated giant cells and foamy histiocytes were present (Fig. 2B). DISCUSSION The first description of the entity now known as PVS is credited to Chassignac (1852) in a case report which he called cancer of the tendon sheath. Jaffc et al.5 introduced the term PVS in i 941, stressed the benign course of the disease, and raised a From the Departments of Radiology,t and Pathology4 Veterans Administration and University Hospitals, University of California at San Diego. 647

2 648 Goergen, Resnick and Niwayama MARcia, i6 FIG. I. Case I. (A) On a lateral roentgenogram of the flexed knee following double-contrast arthrography, the nodular mass is clearly identifiable (arrows). (B) A photograph of the removed and sectioned specimen reveals a fibrous well-circumscribed mass. (C) A photomicrograph (X 135) outlines fibrous proliferation with a villonodular pattern, pigmented cells (arrow), and occasional giant cells (arrowhead). (D) At a higher power of magnification (X54o), round and spindle-shaped cells are present with scattered areas of pigmentation. the possibility of an inflammatory etiology. Exclusive of hand lesions (giant-cell tumor of the tendon sheath), the knee is the most commonly involved joint, and many cases ofdiffuse involvement have been described. Reports of the localized nodular form in the knee have been less frequent. To our knowledge, arthrographic findings have not been reported in nodular PVS. In these two cases, the history suggested a mechanical derangement of the knee involving the menisci. Both patients experienced locking and no masses were palpable. In each case, at surgery a solitary mass was present, firmly attached to the synovium in the region of the infrapatellar fat pad. The lesions were excised and neither has mecurred. Histologic evaluation revealed 11- brous proliferation, a combination of histiocytes, multinucleated giant cells, and hemosidenin-laden macrophages, typical of localized nodular synovitis. In diffuse PVS, the clinical setting usually includes a young adult with chronic knee pain, joint stiffness, synovial thickening, palpable masses, and semosanguincous effusion. The typical amthrographic appearance of the diffuse form is an enlarged joint cavity in association with irregular masses containing villous synovial projections. Patients with localized nodular PVS in the knee usually lack the chronic inflammatory pattern of the diffuse form and most often present with symptoms suggesting a mechanical problem.3 In the absence of a palpable mass, the diagnosis is elusive. Preoperative arthrography may be obtained. Anthrographic technique usually stresses careful, coned examination of the menisci, with less attention directed toward lesions in other parts of the joint. Thus, a localized mass, especially in sites other than

3 VOL. 126, No. 3 Localized Nodular Synovitis of the Knee 649 FIG. 2. Case II. On a lateral roentgenogram of the flexed knee following double-contrast arthrography, a wellcircumscribed shadow (arrows) projects into the anterior aspect of the joint. (B) A photomicrograph (X54o) outlines fibrous tissue admixed with round and spindle-shaped cells. Mildly pigmented cells are occasionally noted (arrow). the suprapatellar bumsa, may be overlooked. Although the nodular masses in localized PVS may be attached to the synovium at any site in the joint or even to a meniscus, our cases are unusual because the masses arose adjacent to the infrapatellar fat pad. The infmapatellar fat pad is an extrasynovial intracapsular structure situated between the patcllam tendon and femoral condyles (Fig. 3A). Synovium reflects oven the fat pad, and a triangular fold, the ligamentum mucosum (alan fold), extends upward and posteriorly to attach in the intercondylar notch. The normal arthrogram outlines a smooth synovial covering over the fat pad. It is usually concave but may rarely be straight or slightly convex in appearance, and is best evaluated on the slightly flexed lateral film (Fig. 3B). A small synovial recess may be present under the inferior portion of the fat pad. Several entities may produce a localized mass or synovial irregularity in the region of the infrapatellar fat pad. Recurrent trauma and inflammation of the fat pad lead to formation of hypertrophic villi which may project into the joint.7 Such damage has been noted in association with meniscal lesions and has also been described as a separate clinical entity, Hoffa s disease.4 Tissue from a medial meniscus tear may displace the fat pad, producing a mass. Similar displacement may rarely result from an intra-articulam ganglion arising from the alar fold ofsvnovium.6 Uncalcified intra-articular bodies may locate in the space over the fat pad between the femoral condyles.8 Finally, other rare synovial tumors such as fibromas, hemangiomas,2 or giant cell tumors7 may produce localized amthrographic defects.

4 6o Goergen, Resnick and Niwayama MARCH, 1976 FIG. 3. Anatomy and normal arthrography. (A) A photograph of a sagittal section of a cadavenic knee demonstrates the infrapatellar fat pad (straight arrow) beneath the patellar tendon (curved arrow). Synovium is reflected over the fat pad (arrowhead) and a small recess is located beneath the fat pad (open arrow). ( B) A lateral view of a normal double-contrast arthrogram reveals a smooth concave synovial covering over the fat pad (arrowhead) and a small inferior synovial recess (open arrow). Donald Resnick, M.D. Department of Radiology Veterans Administration Hospital 3350 La Jolla Village Drive San Diego, California REFERENCES I. CHA5SIGNAC, C. M. E. Cancer de la game des tendons. Gaz. Hop. Civ. Milit., i 852, 47, I 8- I FORREST, j., and STAPLE, T. W. Synovial hemangioma of knee: demonstration by arthrography and arteriography. AM. J. ROENTGENOL., RAD. THERAPY & NUCLEAR MED., 1971, 112, GRANOWITZ, S. P., and MANKIN, H. J. Localized pigmented villonodular synovitis of knee. 7. Bone & Joint Surg., 967, 49-A, I 22-I HOFFA, A. Uber rontgenbilder nach einblasong von sauerstoff in das kniegelenk. Ben. K/in. Wschr., 1906, 43, JAFFE, H. L., LICHTENSTEIN, L., and SUTRO, C. J. Pigmented villonodulan synovitis, bunsitis, and tenosynovitis: discussion of synovial and bursal equivalents of tenosynovial lesion commonly denoted as xanthoma, xanthogranuloma, giant cell tumor, or myeloplexoma of tendon sheath, with some considerations of this tendon sheath lesion itself. Arch. Pathol., 1941, 3!, MUCKLE, D. S., and MANAHAN, P. Intra-articular ganglion of knee. 7. Bone & Joint Surg., 1972, 54-B, !. 7. RICKLIN, P., RUTTIMANN, A., and DEL BUONO, M. S. Meniscus lesions. In: Practical Problems of Clinical Diagnosis, Arthrography, and Therapy. Grune & Stratton, New York, STAPLE, T. W. Extrameniscal lesions demonstrated by double-contrast arthrography of knee. Radiology, 1972, 102, WOLFE, R. D., and GIULIANO, V. J. Doublecontrast arthrography in diagnosis of pigmented villonodular synovitis of knee. AM. J. ROENTGENOL., RAD. THERAPY & NUCLEAR MED., 1970, 110,

5 This article has been cited by: 1. Adam Greenspan, Javier Beltran. Tumoren und tumorartige L?sionen (Tumor-like Lesions) der Gelenke [CrossRef] 2. Donald Resnick, Mark J. Kransdorf. Tumors and Tumor-Like Lesions of Soft Tissues [CrossRef] 3. William P. Docken Pigmented villonodular synovitis: A review with illustrative case reports. Seminars in Arthritis and Rheumatism 9:1, [CrossRef]

triquetrum in rheumatoid arthritis

triquetrum in rheumatoid arthritis Ann. rheum. Dis. (1976), 35, 46 Early abnormalities of pisiform and triquetrum in rheumatoid arthritis DONALD RESNICK From the Department of Radiology, Veterans Administration Hospital, San Diego, and

More information

Multicentric localized giant cell tumor of the tendon. sheath

Multicentric localized giant cell tumor of the tendon. sheath Multicentric localized giant cell tumor of the tendon sheath Toshihiro Akisue, Tetsuji Yamamoto ( ), Teruya Kawamoto, Toshiaki Hitora, Takashi Marui, Tetsuya Nakatani, Takafumi Onga, and Masahiro Kurosaka.

More information

A 24 year old male patient presented with a swelling on the dorsal aspect of left foot since 3 years. He was operated thrice before, outside, for

A 24 year old male patient presented with a swelling on the dorsal aspect of left foot since 3 years. He was operated thrice before, outside, for A 24 year old male patient presented with a swelling on the dorsal aspect of left foot since 3 years. He was operated thrice before, outside, for same. Came to us with recurrence since last one year with

More information

Joints of the Lower Limb II

Joints of the Lower Limb II Joints of the Lower Limb II Lecture Objectives Describe the components of the knee and ankle joint. List the ligaments associated with these joints and their attachments. List the muscles acting on these

More information

Case Study. Your Diagnosis?

Case Study. Your Diagnosis? Case Study 35 year old man twisted his ankle while playing and was surgically for treated for ankle sprain for instability symptoms 2 years. Increasing pain around the ankle and pain present all the time

More information

and K n e e J o i n t Is the most complicated joint in the body!!!!

and K n e e J o i n t Is the most complicated joint in the body!!!! K n e e J o i n t K n e e J o i n t Is the most complicated joint in the body!!!! 1-Consists of two condylar joints between: A-The medial and lateral condyles of the femur and The condyles of the tibia

More information

The Knee Joint By Prof. Dr. Muhammad Imran Qureshi

The Knee Joint By Prof. Dr. Muhammad Imran Qureshi The Knee Joint By Prof. Dr. Muhammad Imran Qureshi Structurally, it is the Largest and the most complex joint in the body because of the functions that it performs: Allows mobility (flexion/extension)

More information

Case Report Extraosseous Intra-Articular Osteochondroma

Case Report Extraosseous Intra-Articular Osteochondroma Case Reports in Orthopedics Volume 2013, Article ID 181862, 5 pages http://dx.doi.org/10.1155/2013/181862 Case Report Extraosseous Intra-Articular Osteochondroma Pragash Mohanen, 1,2 Kumaresan Palania

More information

Ultrasound Evaluation of Masses

Ultrasound Evaluation of Masses Ultrasound Evaluation of Masses Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Disclosures: Consultant: Bioclinica Advisory Panel: GE,

More information

Benjamin E. Plotkin, M.D., Vishal K. Agarwal, M.D., and Rajeev Varma, M.D.

Benjamin E. Plotkin, M.D., Vishal K. Agarwal, M.D., and Rajeev Varma, M.D. Stump Entrapment of the Torn Anterior Cruciate Ligament Benjamin E. Plotkin, M.D., Vishal K. Agarwal, M.D., and Rajeev Varma, M.D. Citation: Plotkin BE, Agarwal VK, Varma R. Stump Entrapment of the Torn

More information

Unlocking the locked Knee

Unlocking the locked Knee Unlocking the locked Knee Poster No.: P-0027 Congress: ESSR 2013 Type: Scientific Exhibit Authors: J. P. SINGH, S. Srivastava, S. S. BAIJAL ; Gurgaon, Delhi 1 1 2 1 2 NCR/IN, LUCKNOW, UTTAR PRADESH/IN

More information

Pigmented Villonodular Synovitis (PVNS) A Case Report

Pigmented Villonodular Synovitis (PVNS) A Case Report Case Report: Pigmented Villonodular Synovitis (PVNS) A Case Report Abhishek Patil 1, Sanjay Mulay 2, Chandrashekar Jaiswal 1, Uday Mahajan 1, Shriniwas Yadkikar 3, Vishnu Yadkikar 4 1Junior Resident, 2

More information

Original Report MR Imaging of Infrapatellar Plica Injury OBJECTIVE. CONCLUSION. Materials and Methods

Original Report MR Imaging of Infrapatellar Plica Injury OBJECTIVE. CONCLUSION. Materials and Methods R. Lee Cothran 1 Philip M. McGuire 1,2 Clyde A. Helms 1 Nancy M. Major 1 David E. Attarian 3 Received October 25, 2001; accepted after revision October 11, 2002. 1 Department of Radiology, Box 3808, Duke

More information

Unusual Lateral Presentation of Popliteal Cyst

Unusual Lateral Presentation of Popliteal Cyst Unusual Lateral Presentation of Popliteal Cyst Tarek Hemmali,* Abstract: The most common cyst occurs in the popliteal region is the popliteal cyst and over the past years it has been received much clinical

More information

Extra articular pigmented villonodular synovitis of knee

Extra articular pigmented villonodular synovitis of knee A Case Report Extra articular pigmented villonodular synovitis of knee Sandeep tripathi 1, Brajesh nandan 2, Manish dhawan 3, VK nijhawan 4 ABSTRACT This study is a case report of a 30 year old male with

More information

Case Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

Case Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old Case Reports in Orthopedics Volume 2016, Article ID 1834740, 4 pages http://dx.doi.org/10.1155/2016/1834740 Case Report Multiple Giant Cell Tumors of Tendon Sheath Found within a Single Digit of a 9-Year-Old

More information

When Pads of Fat are a Welcome Sight: Fat Pads in Acute Musculoskeletal Imaging

When Pads of Fat are a Welcome Sight: Fat Pads in Acute Musculoskeletal Imaging When Pads of Fat are a Welcome Sight: Fat Pads in Acute Musculoskeletal Imaging Poster No.: C-2444 Congress: ECR 2013 Type: Authors: Keywords: DOI: Educational Exhibit M. Zakhary 1, M. Adix 2, C. Yablon

More information

Knee Joint Anatomy 101

Knee Joint Anatomy 101 Knee Joint Anatomy 101 Bone Basics There are three bones at the knee joint femur, tibia and patella commonly referred to as the thighbone, shinbone and kneecap. The fibula is not typically associated with

More information

C HILDREN S knees can be studied by double contrast anthrography just as

C HILDREN S knees can be studied by double contrast anthrography just as APRIL, 197$ DOUBLE CONTRAST KNEE ARTHROGRAPHY IN CHILDREN* By ROBERT T. BRAMSON, and TOM W. STAPLE C HILDREN S knees can be studied by double contrast anthrography just as in adults. The paucity ofinformation

More information

MRI KNEE WHAT TO SEE. Dr. SHEKHAR SRIVASTAV. Sr.Consultant KNEE & SHOULDER ARTHROSCOPY

MRI KNEE WHAT TO SEE. Dr. SHEKHAR SRIVASTAV. Sr.Consultant KNEE & SHOULDER ARTHROSCOPY MRI KNEE WHAT TO SEE Dr. SHEKHAR SRIVASTAV Sr.Consultant KNEE & SHOULDER ARTHROSCOPY MRI KNEE - WHAT TO SEE MRI is the most accurate and frequently used diagnostic tool for evaluation of internal derangement

More information

Pigmented Villonodular Synovitis PVNS

Pigmented Villonodular Synovitis PVNS February 2002 Pigmented Villonodular Synovitis PVNS Amy Gillis, Harvard Medical School Year III 47 year old female Our Patient Right hip pain since age 20 No history of trauma Diagnosed with DJD of R hip

More information

PIGMENTED VILLONODULAR SYNOVITIS OF THE WRIST

PIGMENTED VILLONODULAR SYNOVITIS OF THE WRIST PIGMENTED VILLONODULAR SYNOVITIS OF THE WRIST WITH PENETRATION INTO BONE FRITZ SCHAJOWICZ and ISIDORO BLUMENFELD, BUENOS AIRES, ARGENTINA From the Latin-American Register of Bone Pathology, Hospital Italiano,

More information

Localized Nodular Tenosynovitis in the Horse

Localized Nodular Tenosynovitis in the Horse Path. vet. 5: 436-441 (1968) From the Department of Veterinary Pathology, School of Veterinary Medicine, Washington State University, Pullman Localized Nodular Tenosynovitis in the Horse W.L. RAGLAND 1x1

More information

MRI of the Knee: Part 4 - normal variants that may simulate disease. Mark Anderson, M.D. University of Virginia

MRI of the Knee: Part 4 - normal variants that may simulate disease. Mark Anderson, M.D. University of Virginia MRI of the Knee: Part 4 - normal variants that may simulate disease Mark Anderson, M.D. University of Virginia discuss the most common normal variants in the pediatric knee that may simulate pathology

More information

P IGMENTED villonodular synovi tis is not a new disease, as it was first described

P IGMENTED villonodular synovi tis is not a new disease, as it was first described VOL. 110, No. DOUBLE-CONTRAST ARTHROGRAPHY IN THE DIAGNOSIS OF PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE* By LT. COLONEL RICHARD D. WOLFE, USAF, MC,f and MAJOR VINCENT J. GIULIANO, USA, MC P IGMENTED

More information

Bilateral Shoulder Pain

Bilateral Shoulder Pain HR J Bilateral Shoulder Pain, p. 64-69 Clinical Case - Test Yourself Bilateral Shoulder Pain Musculoskeletal Eirini D. Savva, Rafaela M. Smarlamaki, Foteini I. Terezaki Department of Radiology, University

More information

The Knee. Prof. Oluwadiya Kehinde

The Knee. Prof. Oluwadiya Kehinde The Knee Prof. Oluwadiya Kehinde www.oluwadiya.sitesled.com The Knee: Introduction 3 bones: femur, tibia and patella 2 separate joints: tibiofemoral and patellofemoral. Function: i. Primarily a hinge joint,

More information

Knee: Cruciate Ligaments

Knee: Cruciate Ligaments 72 Knee: Cruciate Ligaments R. Kent Sanders Sagittal oblique 2.5-mm sequences along the plane of the anterior cruciate ligament (ACL) typically yield three to four images of the ACL, with the first medial

More information

GIANT CELL TUMOR OF TENDON SHEATH A CYTO HISTO CORRELATION

GIANT CELL TUMOR OF TENDON SHEATH A CYTO HISTO CORRELATION GIANT CELL TUMOR OF TENDON SHEATH A CYTO HISTO CORRELATION Dr.S.SRIKANTH, Assistant Professor.Dept of Patholgy. Dr.SMITHA VADANA, Resident.Dept of pathology. Dr.R.SUHELA. Resident.Dept Of Pathology. Prathima

More information

Giant-cell tumor of the tendon sheath: when must we suspect it?

Giant-cell tumor of the tendon sheath: when must we suspect it? Giant-cell tumor of the tendon sheath: when must we suspect it? Poster No.: C-0538 Congress: ECR 2014 Type: Educational Exhibit Authors: C. Santos Montón, J. M. Alonso Sánchez, D. C. Cuellar, P. A. Chaparro

More information

TREATMENT OF THE POPLITEAL CYST IN THE RHEUMATOID KNEE. A recent report on the surgical treatment of a popliteal cyst in a patient with rheumatoid

TREATMENT OF THE POPLITEAL CYST IN THE RHEUMATOID KNEE. A recent report on the surgical treatment of a popliteal cyst in a patient with rheumatoid TREATMENT OF THE POPLITEAL CYST IN THE RHEUMATOID KNEE I. M. PINDER, BATH, SOMERSET From the Bath and Wessex Orthopaedic Hospital, Bath A recent report on the surgical treatment of a popliteal cyst in

More information

Localized anterior arthrofibrosis (Cyclops lesion) with no history of anterior cruciate ligament reconstruction: MRI findings.

Localized anterior arthrofibrosis (Cyclops lesion) with no history of anterior cruciate ligament reconstruction: MRI findings. Localized anterior arthrofibrosis (Cyclops lesion) with no history of anterior cruciate ligament reconstruction: MRI findings. Poster No.: P-0145 Congress: ESSR 2013 Type: Scientific Exhibit Authors: L.

More information

CASE REPORT GIANT OSTEOCHONDRAL LOOSE BODY OF THE KNEE JOINT

CASE REPORT GIANT OSTEOCHONDRAL LOOSE BODY OF THE KNEE JOINT Journal of Musculoskeletal Research, Vol. 4, No. 2 (2000) 145 149 World Scientific Publishing Company ORIGINAL CASE REPORT ARTICLES GIANT OSTEOCHONDRAL LOOSE BODY OF THE KNEE JOINT Mustafa Yel *,, Mustafa

More information

To describe he knee joint, ligaments, structure & To list the main features of other lower limb joints

To describe he knee joint, ligaments, structure & To list the main features of other lower limb joints To describe he knee joint, ligaments, structure & neurovascular supply To demonstrate the ankle joint anatomy To list the main features of other lower limb joints To list main groups of lymph nodes in

More information

Figuring out the "fronds"-synovial proliferative disorders of the knee.

Figuring out the fronds-synovial proliferative disorders of the knee. Figuring out the "fronds"-synovial proliferative disorders of the knee. Poster No.: C-1209 Congress: ECR 2014 Type: Educational Exhibit Authors: S. Sivasubramanian; Tamil Nadu/IN Keywords: Imaging sequences,

More information

Comparative study of high resolusion ultrasonography and magnetic resonance imaging in diagnosing traumatic knee injuries & pathologies

Comparative study of high resolusion ultrasonography and magnetic resonance imaging in diagnosing traumatic knee injuries & pathologies Original article: Comparative study of high resolusion ultrasonography and magnetic resonance imaging in diagnosing traumatic knee injuries & pathologies Dr. Rakesh Gujjar*, Dr. R. P. Bansal, Dr. Sandeep

More information

Physical Examination of the Knee

Physical Examination of the Knee History: Pain Traumatic vs. atraumatic Acute vs Chronic Mechanism of injury Swelling, catching, instability Previous evaluation and treatment General Setup Examine standing, sitting and supine Evaluate

More information

Physical Examination of the Knee

Physical Examination of the Knee History: Pain Traumatic vs. atraumatic? Acute vs Chronic Previous procedures done on the knee? Swelling, catching, instability General Setup Examine standing, sitting and supine Evaluate gait Examine hip

More information

Giant Cell Tumor of the Tendon Sheath: Experience With 65 Cases

Giant Cell Tumor of the Tendon Sheath: Experience With 65 Cases Giant Cell Tumor of the Tendon Sheath: Experience With 65 Cases Erin L. Adams, BS, a Eric M. Yoder, MD, MBA, a and Morton L. Kasdan, MD, FACS b a University of Louisville School of Medicine, Louisville,

More information

ELENI ANDIPA General Hospital of Athens G. Gennimatas

ELENI ANDIPA General Hospital of Athens G. Gennimatas ELENI ANDIPA General Hospital of Athens G. Gennimatas Technological advances over the last years have caused a dramatic improvement in ultrasound quality and resolution An established imaging modality

More information

Knee Joint Assessment and General View

Knee Joint Assessment and General View Knee Joint Assessment and General View Done by; Mshari S. Alghadier BSc Physical Therapy RHPT 366 m.alghadier@sau.edu.sa http://faculty.sau.edu.sa/m.alghadier/ Functional anatomy The knee is the largest

More information

Prevention and Treatment of Injuries. Anatomy. Anatomy. Chapter 20 The Knee Westfield High School Houston, Texas

Prevention and Treatment of Injuries. Anatomy. Anatomy. Chapter 20 The Knee Westfield High School Houston, Texas Prevention and Treatment of Injuries Chapter 20 The Knee Westfield High School Houston, Texas Anatomy MCL, Medial Collateral Ligament LCL, Lateral Collateral Ligament PCL, Posterior Cruciate Ligament ACL,

More information

2 A B Fig. 1. Lateral tibial condyle fracture with joint effusion in a 35-year-old man. Sagittal T2-weighted MRI shows a large amount of effusion

2 A B Fig. 1. Lateral tibial condyle fracture with joint effusion in a 35-year-old man. Sagittal T2-weighted MRI shows a large amount of effusion 1 2 1 1 1 2 A B Fig. 1. Lateral tibial condyle fracture with joint effusion in a 35-year-old man. Sagittal T2-weighted MRI shows a large amount of effusion (between arrowheads) in the suprapatellar pouch,

More information

Ultrasound of the Knee

Ultrasound of the Knee Ultrasound of the Knee Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Disclosures: Consultant: Bioclinica Book Royalties: Elsevier Advisory

More information

Other Culprits in Knee Dysfunction

Other Culprits in Knee Dysfunction Unraveling the Mystery of Knee Pain #6: Other Culprits in Knee Dysfunction 1 Webinar Goals Explore the assessment and treatment of other culprits in knee dysfunction. 2 Time: 60 minutes Schedule: Logistics

More information

Original Article Pigmented villonodular synovitis of the elbow with rdial, median and ulnar nerve compression

Original Article Pigmented villonodular synovitis of the elbow with rdial, median and ulnar nerve compression Int J Clin Exp Pathol 2015;8(11):14045-14049 www.ijcep.com /ISSN:1936-2625/IJCEP0016476 Original Article Pigmented villonodular synovitis of the elbow with rdial, median and ulnar nerve compression Hui

More information

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 4: Knee Pain

BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 4: Knee Pain BATES VISUAL GUIDE TO PHYSICAL EXAMINATION OSCE 4: Knee Pain This video format is designed to help you prepare for objective structured clinical examinations, or OSCEs. You are going to observe and participate

More information

Illustrated review of anterior knee pain with Magnetic Resonance.

Illustrated review of anterior knee pain with Magnetic Resonance. Illustrated review of anterior knee pain with Magnetic Resonance. Poster No.: C-2389 Congress: ECR 2013 Type: Educational Exhibit Authors: M. C. Ruibal Villanueva, P. Sucasas-Hermida, M. Rodríguez Álvarez,

More information

FISH VERTEBRAE RADIOLOGIC VIGNETTE DONALD L. RESNICK

FISH VERTEBRAE RADIOLOGIC VIGNETTE DONALD L. RESNICK ~ 1073 RADIOLOGIC VIGNETTE FISH VERTEBRAE DONALD L. RESNICK The term fish verfebru is applied to a vertebral body that has an abnormal shape characterized by biconcavity due to depression of its superior

More information

CLASSIFICATION OF JOINTS STRUCTURAL VS FUNCTIONAL

CLASSIFICATION OF JOINTS STRUCTURAL VS FUNCTIONAL CHAPTER 8 JOINTS CLASSIFICATION OF JOINTS STRUCTURAL VS FUNCTIONAL The most moveable type of joint is a 1) Synarthrosis 2) Amphiarthrosis 3) Diarthrosis FIBROUS JOINTS Figure 8.1 Fibrous joints. (a) Suture

More information

Case Report Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee

Case Report Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with Inability to Flex the Knee Hindawi Publishing Corporation Case Reports in Medicine Volume 0, Article ID 70599, 5 pages doi:0.55/0/70599 Case Report Large Intra-Articular Anterior Cruciate Ligament Ganglion Cyst, Presenting with

More information

FILED: KINGS COUNTY CLERK 04/23/ :08 PM INDEX NO /2016 NYSCEF DOC. NO. 29 RECEIVED NYSCEF: 04/23/2018

FILED: KINGS COUNTY CLERK 04/23/ :08 PM INDEX NO /2016 NYSCEF DOC. NO. 29 RECEIVED NYSCEF: 04/23/2018 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ----------------------------------------------------------------X BETHZAIDA CARO, Plaintiff(s), -against- PHYSICIAN' PHYSICIAN'S AFFIRMATION Index

More information

ORIGINAL ARTICLE. ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIES Saurabh Chaudhuri, Priscilla Joshi, Mohit Goel

ORIGINAL ARTICLE. ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIES Saurabh Chaudhuri, Priscilla Joshi, Mohit Goel ROLE OF MRI IN EVALUATION OF TRAUMATIC KNEE INJURIES Saurabh Chaudhuri, Priscilla Joshi, Mohit Goel 1. Associate Professor, Department of Radiodiagnosis & imaging, Bharati Vidyapeeth Medical College and

More information

Arthritic history is similar to that of the hip. Add history of give way and locking, swelling

Arthritic history is similar to that of the hip. Add history of give way and locking, swelling KNEE VASU PAI Arthritic history is similar to that of the hip. Add history of give way and locking, swelling INJURY MECHANISM When How Sequence Progress Disability IKDC Activity I - Strenuous activity

More information

Joints: Part B 10/30/14. Classification of Synovial Joints. Six types, based on shape of articular surfaces: Plane Joints

Joints: Part B 10/30/14. Classification of Synovial Joints. Six types, based on shape of articular surfaces: Plane Joints PowerPoint Lecture Slides prepared by Janice Meeking, Mount Royal College C H A P T E R 8 Joints: Part B Classification of Synovial Joints Six types, based on shape of articular surfaces: Plane Hinge Pivot

More information

Remote ACL tear and medial meniscus surgery. Recent ACL reconstruction surgery 4mths ago. Continued anterior knee pain and difficulty extension.

Remote ACL tear and medial meniscus surgery. Recent ACL reconstruction surgery 4mths ago. Continued anterior knee pain and difficulty extension. Remote ACL tear and medial meniscus surgery. Recent ACL reconstruction surgery 4mths ago. Continued anterior knee pain and difficulty extension. Space between the infrapatellar fat

More information

What is Medial Plica Syndrome?

What is Medial Plica Syndrome? What is Medial Plica Syndrome? It is a congenital disorder in which the thin wall of fibrous tissue extends from the synovial capsule of the knee. Pain usually occurs when the synovial capsule becomes

More information

SLAP Lesions of the Shoulder

SLAP Lesions of the Shoulder Arthroscopy: The Journal of Arthroscopic and Related Surgery 6(4):21&279 Published by Raven Press, Ltd. Q 1990 Arthroscopy Association of North America SLAP Lesions of the Shoulder Stephen J. Snyder, M.D.,

More information

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION

CLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 12/01/2012 Radiology Quiz of the Week # 101 Page 1 CLINICAL PRESENTATION AND RADIOLOGY

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute. MRI of the Knee Jennifer Swart, M.D. Musculoskeletal Radiology South Texas Radiology Group Outline Coils, Patient Positioning Acquisition Parameters, Planes and Pulse Sequences Knee Arthrography Normal

More information

8/4/2012. Causes and Cures. Nucleus pulposus. Annulus fibrosis. Vertebral end plate % water. Deforms under pressure

8/4/2012. Causes and Cures. Nucleus pulposus. Annulus fibrosis. Vertebral end plate % water. Deforms under pressure Causes and Cures Intervertebral discs Facet (zygopophyseal) joints Inter body joints Spinal nerve roots Nerve compression Pathological conditions Video Causes of back pain Nucleus pulposus Annulus fibrosis

More information

Joints. Judi Laprade. Illustrations from: Essential Clinical Anatomy 3 rd ed. (ECA3) Moore, K. and Agur, A. Lippincott Williams and Wilkins, 2007

Joints. Judi Laprade. Illustrations from: Essential Clinical Anatomy 3 rd ed. (ECA3) Moore, K. and Agur, A. Lippincott Williams and Wilkins, 2007 Slide 1 Joints Judi Laprade Illustrations from: Essential Clinical Anatomy 3 rd ed. (ECA3) Moore, K. and Agur, A. Lippincott Williams and Wilkins, 2007 Grant s Atlas of Anatomy 12 th ed. (GA12) Agur, A.

More information

Radiological Reasoning: Acutely Painful Swollen Finger. Musculoskeletal Imaging Chew and Richardson Benign-Appearing Bone Mass.

Radiological Reasoning: Acutely Painful Swollen Finger. Musculoskeletal Imaging Chew and Richardson Benign-Appearing Bone Mass. Musculoskeletal Imaging Chew and Richardson Benign-Appearing Bone Mass AJR Integrative Imaging LIFELONG LEARNING FOR RADIOLOGY This Radiological Reasoning article is available for SAM credit and CME credits

More information

This presentation is the intellectual property of the author. Contact them at for permission to reprint and/or distribute.

This presentation is the intellectual property of the author. Contact them at for permission to reprint and/or distribute. MRI of the Knee Jennifer Swart, M.D. Musculoskeletal Radiology South Texas Radiology Group Financial Disclosure Dr. Jennifer Swart has no relevant financial relationships with commercial interests to disclose.

More information

UNIT 7 JOINTS. Knee and Ankle Joints DR. ABDEL-MONEM A. HEGAZY

UNIT 7 JOINTS. Knee and Ankle Joints DR. ABDEL-MONEM A. HEGAZY UNIT 7 JOINTS Knee and Ankle Joints BY DR. ABDEL-MONEM A. HEGAZY (Degree in Bachelor of Medicine and Surgery with honor 1983, Dipl."Gynaecology and Obstetrics "1989, Master "Anatomy and Embryology "1994,

More information

Intra-articular soft tissue masses of the knee: An imaging review of biopsy proven diagnoses

Intra-articular soft tissue masses of the knee: An imaging review of biopsy proven diagnoses Intra-articular soft tissue masses of the knee: An imaging review of biopsy proven diagnoses Poster No.: P-0114 Congress: ESSR 2014 Type: Scientific Poster Authors: A. Kirwadi 1, S. Raniga 2, R. Hargunani

More information

W. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco

W. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco Knee Pain And Injuries In Adults W. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco Pain Control Overview Narcotics rarely necessary after 1 st 1-2

More information

OSTEOPHYTOSIS OF THE FEMORAL HEAD AND NECK

OSTEOPHYTOSIS OF THE FEMORAL HEAD AND NECK 908 RDIOLOGIC VIGNETTE OSTEOPHYTOSIS OF THE FEMORL HED ND NECK DONLD RESNICK Osteophytes are frequently considered the most characteristic abnormality of degenerative joint disease. In patients with osteoarthritis,

More information

What s your diagnosis?

What s your diagnosis? Case Study 58 A 61-year-old truck driver man presented with a valgus injury to the left knee joint when involved in a truck accident. What s your diagnosis? Diagnosis : Avulsion of Deep MCL The medial

More information

Non-traumatic Lesions of the Anterior Cruciate Ligament on MRI: an Updated Review

Non-traumatic Lesions of the Anterior Cruciate Ligament on MRI: an Updated Review Non-traumatic Lesions of the Anterior Cruciate Ligament on MRI: an Updated Review Poster No.: P-0017 Congress: ESSR 2016 Type: Educational Poster Authors: P. Melloni, M. T. Veintemillas, A. Marin, C. Cano

More information

Case study #11 Rt. knee

Case study #11 Rt. knee The patient is a 55 year old female who presents with bilateral knee pain. Patient is a collegiate softball coach and has a very active lifestyle and career that is hampered by her chronic knee pain. She

More information

CMEArticle Clinics in diagnostic imaging (141)

CMEArticle Clinics in diagnostic imaging (141) Singapore Med J 2012; 53(9) : 625 CMEArticle Clinics in diagnostic imaging (141) Hollie MY Lim 1, MBBS, FRCR, Wilfred CG Peh 1, FRCP, FRCR 1a 1b 1c Fig. 1 (a & b) Contiguous sagittal fat-suppressed PD-W

More information

Chapter 9 Articulations Articulations joints where two bones interconnect. Two classification methods are used to categorize joints:

Chapter 9 Articulations Articulations joints where two bones interconnect. Two classification methods are used to categorize joints: Chapter 9 Articulations Articulations joints where two bones interconnect Two classification methods are used to categorize joints: Functional classification Structural classification Functional classification

More information

Arthrographic study of the rheumatoid knee.

Arthrographic study of the rheumatoid knee. Annals of the Rheumatic Diseases, 1981, 40, 332-343 Arthrographic study of the rheumatoid knee. Part 1. Synovial proliferation KYOSUKE FUJIKAWA From the Department of Orthopaedic Surgery, School of Medicine,

More information

Articulations. Articulation. Joint between bones. Does not mean movement! Some joints are immovable; sutures.

Articulations. Articulation. Joint between bones. Does not mean movement! Some joints are immovable; sutures. Articulations Joint between bones Articulation Does not mean movement Some joints are immovable; sutures. Classification of joints Two questions about joints: 1- How does it move? - functional 2- How is

More information

Dupuytren's Contracture Assessment

Dupuytren's Contracture Assessment Dupuytren's Contracture Assessment Link to guidance: http://www.enhertsccg.nhs.uk/ bedfordshire-and-hertfordshire-priorities-forum Dupuytren's contracture - clinical presentation for patients History Examination

More information

Arthrographic study of the rheumatoid knee.

Arthrographic study of the rheumatoid knee. Annals of the Rheumatic Diseases, 1981, 40, 344-349 Arthrographic study of the rheumatoid knee. Part 2. Articular cartilage and menisci KYOSUKE FUJIKAWA, YOSHINORI TANAKA, TSUNEYO MATSUBAYASHI, AND FUJIO

More information

ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB.

ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB. ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB www.fisiokinesiterapia.biz Overview History Examination X-rays Fractures and Dislocations. Soft Tissue Injuries Other Knee/Lower limb Problems Anatomy

More information

The Meniscus. History. Anatomy. Anatomy. Blood Supply. Attachments

The Meniscus. History. Anatomy. Anatomy. Blood Supply. Attachments History The Meniscus W. Randall Schultz, MD, MS Austin, TX January 23, 2016 Meniscus originally thought to represent vestigial tissue 1883 first reported meniscal repair (Annandale) Total menisectomy treatment

More information

Original Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus

Original Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus Eva M. Escobedo 1 William J. Mills 2 John. Hunter 1 Received July 10, 2001; accepted after revision October 1, 2001. 1 Department of Radiology, University of Washington Harborview Medical enter, 325 Ninth

More information

Joints Outline 8.1 Joints are classified into three structural and three functional categories (p. 251; Table 8.1) A. Joints are classified by

Joints Outline 8.1 Joints are classified into three structural and three functional categories (p. 251; Table 8.1) A. Joints are classified by Joints Outline 8.1 Joints are classified into three structural and three functional categories (p. 251; Table 8.1) A. Joints are classified by structure and by function: Structural classification focuses

More information

Mucoid degeneration of the posterior cruciate ligament

Mucoid degeneration of the posterior cruciate ligament Mucoid degeneration of the posterior cruciate ligament Poster No.: C-2278 Congress: ECR 2010 Type: Educational Exhibit Topic: Musculoskeletal - Joints Authors: P. Papadopoulou, I. Kalaitzoglou, I. Tsifoundoudis,

More information

CONSULTATION DURING SURGERY / NOT A FINAL DIAGNOSIS. FROZEN SECTION DIAGNOSIS: - A. High grade sarcoma. Wait for paraffin sections results.

CONSULTATION DURING SURGERY / NOT A FINAL DIAGNOSIS. FROZEN SECTION DIAGNOSIS: - A. High grade sarcoma. Wait for paraffin sections results. Pathology Report Date: 3/5/02 A, B. Biopsy right distal femur- high grade spindle cell sarcoma Immunohistochemistry studies are pending to further classify the nature of the tumor. CONSULTATION DURING

More information

COMMON KNEE AND SHOULDER INJURIES IN THE YOUNG ATHLETE. Outline 5/11/2017

COMMON KNEE AND SHOULDER INJURIES IN THE YOUNG ATHLETE. Outline 5/11/2017 COMMON KNEE AND SHOULDER INJURIES IN THE YOUNG ATHLETE IRVING RAPHAEL MD Syracuse Orthopedic Specialists Former S.U. Head Team Physician May 19, 2017 Meniscal Injuries anatomy Exam Treatment ACL Injuries

More information

Impingement Syndromes of the Ankle. Noaman W Siddiqi MD 5/4/2006

Impingement Syndromes of the Ankle. Noaman W Siddiqi MD 5/4/2006 Impingement Syndromes of the Ankle Noaman W Siddiqi MD 5/4/2006 Ankle Impingement Overview Clinical DX Increasingly recognized cause of chronic ankle pain Etiology can be soft tissue or osseous Professional

More information

Ultrasound of the Hip: Anatomy, Pathology, and Procedures

Ultrasound of the Hip: Anatomy, Pathology, and Procedures Ultrasound of the Hip: Anatomy, Pathology, and Procedures Jon A. Jacobson, M.D. Professor of Radiology Director, Division of Musculoskeletal Radiology University of Michigan Outline Hip Joint Native hip

More information

MRI of distended bursa around the knee

MRI of distended bursa around the knee MRI of distended bursa around the knee Poster No.: C-2240 Congress: ECR 2010 Type: Educational Exhibit Topic: Musculoskeletal Authors: P. Papadopoulou, I. Kalaitzoglou, N. Michailidis, I. Tsifoundoudis,

More information

Case study #12 Left knee

Case study #12 Left knee The patient is a 55 year old female who presents with bilateral knee pain. Patient is a collegiate softball coach and has a very active lifestyle and career that is hampered by her chronic knee pain. She

More information

* Articular system I

* Articular system I *Articular system I *Articular system=syndesmology (Systema articulare) System of joints Joint occurs, where 2 bones meet Combine bones of skeleton into a single unit Provide mobility *Classification

More information

Giant Cell Tumor of Tendon Sheath in Guyon s Canal Causing Ulnar Tunnel Syndrome A Case Report and Review of the Literature

Giant Cell Tumor of Tendon Sheath in Guyon s Canal Causing Ulnar Tunnel Syndrome A Case Report and Review of the Literature Giant Cell Tumor of Tendon Sheath in Guyon s Canal Causing Ulnar Tunnel Syndrome A Case Report and Review of the Literature Ben S. Francisco, BA a and Jayant P. Agarwal, MD b a School of Medicine, University

More information

Suprapatellar fat-pad impingement:mri findings

Suprapatellar fat-pad impingement:mri findings Suprapatellar fat-pad impingement:mri findings Poster No.: C-1672 Congress: ECR 2017 Type: Scientific Exhibit Authors: A. Arslan, S. Ulus, S. A. Kara, O. SAYG#L#; istanbul/tr Keywords: Trauma, Diagnostic

More information

MR imaging of the knee in marathon runners before and after competition

MR imaging of the knee in marathon runners before and after competition Skeletal Radiol (2001) 30:72 76 International Skeletal Society 2001 ARTICLE W. Krampla R. Mayrhofer J. Malcher K.H. Kristen M. Urban W. Hruby MR imaging of the knee in marathon runners before and after

More information

Pigmented villonodular synovitis of the temporomandibular joint computed tomography and magnetic resonance findings: a case report

Pigmented villonodular synovitis of the temporomandibular joint computed tomography and magnetic resonance findings: a case report CASE REPORT http://dx.doi.org/10.5125/jkaoms.2014.40.3.140 pissn 2234-7550 eissn 2234-5930 Pigmented villonodular synovitis of the temporomandibular joint computed tomography and magnetic resonance findings:

More information

Medical Diagnosis for Michael s Knee

Medical Diagnosis for Michael s Knee Medical Diagnosis for Michael s Knee Introduction The following report mainly concerns the diagnosis and treatment of the patient, Michael. Given that Michael s clinical problem surrounds an injury about

More information

Lipoma Arborescens of Subacromial-subdeltoid Bursa: Ultrasonographic Findings

Lipoma Arborescens of Subacromial-subdeltoid Bursa: Ultrasonographic Findings C A S E R E P O R T Lipoma Arborescens of Subacromial-subdeltoid Bursa: Ultrasonographic Findings Amelia Bargiela*, Esther Rodriguez, Rafaela Soler The present study describes the ultrasound findings of

More information

Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee

Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee Instructor: Ben Benjamin, Ph.D. Instructor: Ben Benjamin, Ph.D. 1 Webinar Goals Understand the significance of

More information

Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee

Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee Unraveling the Mystery of Knee Pain #2: Client History & The 23 Injuries Common to the Knee Instructor: Ben Benjamin, Ph.D. 1 Instructor: Ben Benjamin, Ph.D. Webinar Goals Understand the significance of

More information

Case series. Hoffa s fat pad tumours like: results of the arthroscopic resection. Open Access

Case series. Hoffa s fat pad tumours like: results of the arthroscopic resection. Open Access Case series Open Access Hoffa s fat pad tumours like: results of the arthroscopic resection Atif Mechchat 1,&, Hatim Abid 1, Hammou Nassreddine 1, Soufiane Bensaad 1, Elidrissi Mohammed 1, Shimi Mohammed

More information

Anatomy and Physiology 1 Chapter 9 self quiz Pro, Dima Darwish,MD.

Anatomy and Physiology 1 Chapter 9 self quiz Pro, Dima Darwish,MD. Anatomy and Physiology 1 Chapter 9 self quiz Pro, Dima Darwish,MD. 1) Joints can be classified structurally as A) bony. B) fibrous. C) cartilaginous. D) synovial. E) All of the answers are correct. 2)

More information