Limb amputation is one of the oldest known surgical procedures performed for a variety of indications. Little surgical technical improvements have been made since the first procedure, but perioperative and post-operative refinements have occurred over time. Post-amputation pain (PAP) of the stump is a common complication but is an extremely challenging condition to treat. Imaging allows early diagnosis of the underlying cause so that timely intervention is possible to minimize physical disability with its possible psychological and socioeconomic implications. A multidisciplinary approach should be taken involving the rehabilitation medicine team, surgeon, prosthetist, occupational therapist and social workers. Conventional radiographs demonstrate the osseous origin of PAP while high-resolution ultrasound is preferred to assess soft-tissue abnormalities. These are often the first-line investigations. MRI remains as a problemsolving tool when clinical and imaging findings are equivocal. This article aimed to raise a clear understanding of common pathologies expected in the assessment of PAP. A selection of multimodality images from our Specialist Mobility and Rehabilitation Unit are presented so that radiologists are aware of and recognize the spectrum of pathological conditions involving the amputation stump. These include but are not limited to aggressive bone spurs, heterotopic ossification, soft-tissue inflammation (stump bursitis), collection, nervosas, osteomyelitis etc. The role of the radiologist in reaching the diagnosis early is vital so that appropriate treatment can be instituted to limit long-term disability. The panel of authors hopes this article helps readers identify the spectrum of pathological conditions involving the post-amputation stump by recognizing the imaging features of the abnormalities in different imaging modalities.

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Aim The number of known neuromuscular conditions has increased significantly with recent advances detailing molecular characteristics and this can present a diagnostic challenge. In addition to the clinical presentation and investigations such as muscle biopsy and neurophysiology the magnetic resonance imaging (MRI) pattern of muscle involvement can provide useful information towards achieving a diagnosis. Our aim was to evaluate the use of skeletal muscle MRI as a diagnostic tool in a relatively small neuromuscular service. Methods Children with a suspected neuromuscular disorder but without a specific diagnosis had muscle MRI performed. All children had T1-weighted imaging at two levels (the thigh and lower limb). Some cases also had T2-weighted or short tau inversion recovery (STIR) imaging. The scans were jointly reviewed by a paediatric neurologist and a radiologist with an interest in musculoskeletal imaging. Results Since 2007 13 children have had skeletal muscle MRI in this centre. In 3 patients the pattern of MRI involvement contributed directly to the diagnosis and in 2 cases it helped direct the muscle biopsy. In a further 3 patients a normal MRI helped in a decision to avoid, or at least defer, a muscle biopsy. Details of their clinical presentations and MRI findings are presented. Conclusion Muscle MRI is a useful tool in the diagnostic process of children with suspected neuromuscular disorders. We believe that our experience demonstrates its benefits in a relatively small service.