The distal semimembranosus tendon divides into five tendinous arms named the anterior, direct, capsular, inferior and the oblique popliteal ligament. These arms intertwine with the branches of the posterior oblique ligament in the posterior medial aspect of the knee, providing stability. This tendon-ligamentous complex also acts synergistically with the popliteus muscle and actively pulls the posterior horn of the medial meniscus during knee flexion. Pathologic conditions involving this complex include complete and partial tears, insertional tendinosis, avulsion fractures and bursitis.
This review presents techniques to optimize bone scintigraphy for evaluation of the spectrum of abnormalities associated with pediatric osteomyelitis, with an emphasis on the approaches to patient preparation and positioning and to interpretation. The diagnosis of pediatric osteomyelitis can be challenging for several different reasons. Bone scintigraphy is especially useful when the site of osteomyelitis is unclear. Other imaging modalities, including radiography, ultrasonography, and magnetic resonance imaging, all have advantages and may have a role in evaluating the condition of the child with osteomyelitis. Pathophysiologic considerations unique to children contribute to a different clinical presentation of osteomyelitis in the pediatric population than that seen in adults. In addition, patient movement degrades image quality substantially, which is an important consideration for imaging children. Neonates have a higher incidence of multifocal osteomyelitis, and they represent a unique subset of the pediatric population with separate considerations. Several examples illustrate techniques to optimize imaging, as well as show the spectrum of abnormalities associated with pediatric osteomyelitis. Careful attention to bone scintigraphic technique ensures that high-quality images can be obtained, which will allow confident diagnosis of pediatric osteomyelitis.
Shoulder instability can be due to a single, acute traumatic event, generalized joint laxity, or repeated episodes of microtrauma. The later occurs in the throwing athlete. The most common lesion involving the labrum is the anterior inferior labral tear, associated with capsuloperiosteal stripping (classic Bankart lesion). A number of variants of the Bankart lesion have been described recently and include the ALPSA lesion, SLAP lesion, and HAGHL lesion, among others. Lesions of the long head of the biceps tendon can be seen in isolation (tears, tendinosis, dislocation) or in association with rotator cuff and labral lesions. Conventional MR and MR arthrography have been extensively used for the preoperative diagnosis of these lesions, with reportedly good accuracy. An understanding of the normal anatomy and biomechanics of the shoulder joint is essential for proper interpretation of the MRI manifestations of these conditions.
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