Dr Joachim Feger et al. Subacromial impingement is elicited in flexion or abduction. Two characteristic forms of microtraumatic instability will be discussed. Patients with COVID-19 have developed several autoimmune conditions, such as rheumatoid arthritis (RA), psoriatic arthritis, and systemic lupus erythematosus, after the onset of infection (10). Tim B. Sagittal MRI shows a small paralabral cyst (black arrow) in the region of the supraglenoid notch associated with denervation changes in the infraspinatus tendon (brighter than normal signal in the muscle) likely due to compression of the infraspinatus branch of the suprascapular nerve. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Patients often complain of pain and instability at the joint. SLAP tear. Gross anatomy. The tendon has intra-articular and extra-articular components. The anterior and posterior ethmoidal arteries are responsible for arterial supply. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. Corticosteroid therapy, likely the leading cause of ON, is administered to severely and critically ill patients who require ventilation to reduce morbidity and mortality and may be used in high doses over prolonged periods. (A) Coronal T2-weighted fat-suppressed MR image of the right shoulder in a 34-year-old woman with persistent pain and limited range of motion 2 months after receiving the Pfizer-BioNTech mRNA COVID-19 vaccine. The superior glenohumeral ligament (as part of the biceps pulley along with the coracohumeral ligament) is important in stabilization of the long head of the biceps tendon. Myonecrosis can result in substantial pain, and patients are treated supportively. These include the sublabral recess, sublabral foramen, and the Buford complex. Two MRI patterns have been described: type 1 myonecrosis reflects potentially reversible muscle ischemia, and type 2 myonecrosis results from irreversible muscle infarction. The IGHL also appears thickened diffusely (solid arrows). Then microinstability (microtraumatic instability) will be defined and the associated lesions of superior labral anterior to posterior (SLAP) and SLAC tears will be outlined. Nasir A. Siddiqui, Mauricio S. Galizia, Emad Almusa, Imran M. Omar. Anticoagulation therapy is the biggest risk factor for developing spontaneous muscle hematoma. 2. Moore KL, II AF, Agur AM. Axial MRI shows a synchondrosis (black arrow) of the unfused os acromiale. PostCOVID-19 condition may be seen in 10%20% of patients, generally in younger individuals between 20 and 50 years of age. In general, the aetiology of impingement can Figure 13. No signs of left glenohumeral osteoarthritis are depicted. These include synovitis, bleeding, infection, or an allergic reaction. Figure 12-26. Critical illness, obesity, male sex, and history of coronary artery disease are the greatest risk factors for developing this complication (39). [2], Posteriorly, the femoral attachment of the synovial membrane is located at the cartilaginous margin of the lateral and medial femoral condyles, where the joint space has two dorsal extensions. First, SLAP lesions will be outlined. Make the changes yourself here! SARS-CoV-2 is an enveloped single-stranded positive-sense messenger RNA (mRNA) virus from the same family of coronaviruses as severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV) that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), respectively. Found an error? Multifocal ON of the foot in a 66-year-old nondiabetic woman who presented with COVID toes. This website uses cookies to improve your experience while you navigate through the website. WebTwenty-two arthroscopic procedures to treat anterolateral soft tissue impingement of the ankle joint were performed at the Independent Public Regional Hospital of Trauma Surgery in Piekary Slaskie between 2006 and 2007. The clavicle is further stabilized by the trapezius and deltoid that attach to the clavicle, acromion, and spine of scapula, posteriorly and anterolaterally, respectively. 50% (957/1903) L 5 ligament (ATFL). Each sinus is lined by a ciliated pseudostratified epithelium, interspersed with mucus-secreting goblet cells. WebResults: Four CT patterns were identified: type 0, uniform filling of the recess with clear limits; type I, intraarticular linear structure outlined by contrast agent; type II, nodular formation in the lateral groove; and type III, irregular (A) Axial fused PET/CT image through the hips in a 55-year-old woman with prolonged hospitalization for COVID-19 and progressive hip stiffness shows extensive bulky HO (arrows) at the posterolateral aspect of both acetabula that is partially adherent to the underlying bone and mildly hypermetabolic. In the MSK system, skeletal muscle, adipocytes, and endothelial cells in some tissues express ACE2 receptors, representing potential targets for SARS-CoV-2 infection, which may explain some MSK manifestations of disease (6). Figure 12-15. Normal findings after the Bankart procedure include fraying/blunting of the labrum, metallic artifact at the anterior inferior glenoid, and thickening of the joint capsule. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-22122. The throwing mechanism consists of phases described as wind up, early cocking, late cocking/early acceleration, late acceleration, and follow-through (deceleration). COVID-19 patients may present with articular or periarticular pain, which can be secondary to osteonecrosis (ON). Acute MSK symptoms, which occur within 4 weeks of infection, including fatigue and myalgia, are nonspecific (3). Note bright signal fluid is replacing the torn tendon. This is most commonly seen in teens and young adults, especially in immunocompetent patients or those with mild COVID-19 symptoms. A glenolabral articular disruption (GLAD) lesion is a nondisplaced anterior inferior labral tear with adjacent chondral injury. Chronic muscle atrophy. Perthes on ABER. Lateral aspect. There are four paired sinuses - named according to the bone in which they are located - maxillary, frontal, sphenoid and ethmoid. the posterior recesses of the ankle and subtalar joint is consistent with a degree of active posterior impingement. Spontaneous bleeding most commonly occurs in skeletal muscle, especially the iliopsoas, as well as the pectoralis major and rectus abdominis muscles (41,42). The value of diaphragmatic US in patients who require ventilators is still being assessed and may also depend on the mode of ventilation. The middle glenohumeral ligament (Figure 12-3) is most easily appreciated deep to the subscapularis tendon. 2010;195 (6): W447-55. Bursal and articular surface rotator cuff tears. This increases intramedullary pressure and may cause vascular occlusion and venous stasis (13). In the adult, its role is poorly understood, and there are several hypothesized functions 2: maintains the upright position as it is tightest when erect and weight-bearing, additional hip stabilizer in patients with generalized ligamentous laxity, hip dysplasia and in patients with anteroinferior acetabular deficiency, maintains lubrication in the joint by aiding the distribution of synovial fluid, congenital absence of the ligamentum teres 3, avulsion fracture of the fovea capitis (see case 3), ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Figure 12-22. Figure 12-23. Figure 12-7. Long-standing diaphragmatic dysfunction is seen in up to 76% of COVID-19 patients and can contribute to dyspnea in the postCOVID-19 condition. Autoimmunity due to SARS-CoV-2 infection may also be related to superantigen reactivity (12). If there is enough fatty infiltration, the overall muscle cross-sectional area may not be significantly reduced. There may also be associated muscle edema with fluid-sensitive sequences, and/or decreased muscle bulk and muscle fatty atrophy on T1-weighted nonfat-suppressed images corresponding to a peripheral nerve distribution (51) (Fig 16). Coronal oblique MRI shows calcium hydroxyapatite deposition in the supraspinatus at its insertion on the footprint is associated with mild adjacent edema (black arrow). Sagittal fat-saturated MRI of the shoulder shows a gap in the anterior aspect of the supraspinatus that traverses the entire width of the tendon from the bursal to the articular surface (black arrow) consistent with a full-thickness tear. The ligament is lined by synovium. Additionally, patients who have undergone sedation and who are critically ill are often unable to alert clinicians of their MSK symptoms. Figure 12-24. In comparison, inflammatory arthritis occurring with other viral infections usually manifests during the acute viremic phase of infection and is more commonly polyarticular (28). They drain into the nasal cavity at the hiatus semilunaris, underneath the frontal sinus opening. This classification was proposed by Geist 7 in 1914 and remains the most widely used classification system (c. 2021). The fabella can also be fibrocartilaginous in nature and is occasionally found in the medial head of the gastrocnemius. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-24771, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":24771,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lisfranc-ligament/questions/1246?lang=us"}. With quiet breathing, the normal excursion has been reported as 10 mm for men and 9 mm for women. The anterolateral gutter or recess of the ankle is. The Lisfranc ligament refers to the most important ligament of the Lisfranc joint ligamentous complex. The tendon and bone findings could be related to deep needle placement through the bursa and into the substance of the tendon. Many severely ill COVID-19 patients undergo periodic chest CT and abdominal CT examinations for respiratory and gastrointestinal symptoms, which may help detect radiographically occult ON of the humeral and femoral heads (17) (Fig 2). These findings are consistent with compete retear of the supraspinatus. Structural causes for subacromial impingement are due to coracoacromial arch abnormalities: the shape and slope of the acromion, an os acromiale, coracoacromial ligament thickening, or acromioclavicular separation. Figure 12-29. Adhesive capsulitis in a 46-year-old woman who developed atraumatic left shoulder pain and decreased range of motion 2 months after recovering from mild symptoms of COVID-19. The serum creatine kinase level briefly peaked at 645 units/L (normal, 0223 units/L) and quickly normalized. This condition is multifactorial due to capsular insufficiency that may be secondary to congenital laxity, a significant traumatic event, or repetitive microtraumatic events. T1 fat-suppressed images in the three conventional planes and ABER view are obtained along with a T2-weighted sequence without fat suppression. Several factors likely contribute to its pathogenesis, including sarcopenia, critical illness myopathy, and ventilator-induced dysfunction. Lastly, there is a synoptic discussion of common surgical procedures for impingement and instability along with common operative and postoperative complications of these techniques. Webchronic anterolateral instability of the ankle joint have been described [4, 6]. The upper extremity, particularly the ulnar nerve and brachial plexus, is more commonly affected than the lower extremity. Other categories of peripheral neuropathy with described imaging findings in COVID-19 patients include position-related, compressive, and postinfectious neuropathies that may be related to thrombotic microangiopathy (Fig 15). MRI, CT, or US can be performed to detect well-described chronic muscle changes (Fig 17). The end-stage of the process is arthritis and joint destruction. (2018) Journal of orthopaedic surgery and research. (C) Axial T2-weighted fat-suppressed MR image of the pelvis inferior to A shows edema of the left femoral nerve (arrow), consistent with compressive neuropathy. Peripheral Polyneuropathy Associated with COVID-19 in Two Patients: A Musculoskeletal Ultrasound Case Report, Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study, A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021, Skeletal muscle alterations in patients with acute Covid-19 and post-acute sequelae of Covid-19, COVID-19 related muscle denervation atrophy, Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know, Shear-Wave Elastography: Basic Physics and Musculoskeletal Applications, Feasibility of assessment of skeletal muscle mass on a single cross-sectional image at the level of the fourth thoracic vertebra, Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19, Diaphragm dysfunction in severe COVID-19 as determined by neuromuscular ultrasound, Shoulder Injury Related to Vaccine Administration, Shoulder Injury after Vaccination: A Systematic Review, Shoulder injury related to vaccine administration (SIRVA) following mRNA COVID-19 vaccination: Report of 2 cases of subacromial-subdeltoid bursitis, Getting it in the right spot: Shoulder injury related to vaccine administration (SIRVA) and other injection site events, Management of Unilateral Axillary Lymphadenopathy Detected on Breast MRI in the Era of COVID-19 Vaccination, Septic Arthritis of the Shoulder After SARS-CoV-2 Pfizer Vaccination: A Case Report, Magnetic resonance imaging of the shoulder, Spectrum of short-term inflammatory musculoskeletal manifestations after COVID-19 vaccine administration: a report of 66 cases, Low frequency of disease flare in patients with rheumatic musculoskeletal diseases who received SARS-CoV-2 mRNA vaccine, Guillain-Barre syndrome following COVID-19 vaccines: A scoping review, Open in Image Posterior aspect. However, COVID toes may be associated with ON of the small bones of the feet, diagnosed at MRI, in patients without other common causes for ON (Fig 3). Considering the glenohumeral joint not a weight-bearing joint, de novo osteoarthritis is less common, and posttraumatic versus calcium pyrophosphate deposition disease (CPPD) should be considered in cases of severe osteoarthritis of the shoulder. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. Figure 12-25. As with other causes, potential COVID-19 vaccinerelated rotator cuff, bursal, and other periarticular soft-tissue pathologic conditions may be diagnosed with MRI or US, while MRI remains the primary modality for glenohumeral joint evaluation (77). Variations in labral attachment and congenital deficiency may be confused with pathology. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. WebNovember 7, 2022. 4. Classification. Furthermore, COVID-19 vaccinations have resulted in rare MSK-related complications, which have additional imaging findings. Grade 6 separation differs from grade 5 injuries as the clavicle is inferiorly displaced. The function of the paranasal sinuses is a topic of much debate. - "Diagnosis of Anterolateral Ankle Impingement" With its free upper margin, this fold extends dorsally through the joint space to surround the two cruciate ligaments from the front, thus dividing the surrounding joint space into two chambers. It is named after Jacques Lisfranc De Saint Martin(1790-1847), French surgeon 2. FABELLA (SESAMOID IN THE LATERAL HEAD OF THE GASTROCNEMIUS). Necessary cookies are absolutely essential for the website to function properly. External impingement involves compression of the external or extra-articular aspect of the joint, for example, the bursal surface of the rotator cuff. Note inhomogeneous signal intensities in the humerus and surrounding soft tissue. There is literature reporting rare inflammatory MSK manifestations following COVID-19 vaccination, including reactive inflammatory arthropathies as well as flares of existing rheumatologic conditions and GBS, suggesting an autoimmune response. The early imaging findings of HO are better depicted at CT than radiography, with peripheral soft-tissue mineralization gradually maturing to cortical bone with internal cancellous bone, which subsequently may attach to the underlying bone surface (20) (Fig 4). Note the diffuse lower leg posterior compartment muscle edema, consistent with denervation. Calcium deposition can be seen in the rotator cuff, bursae, or in the tissues around the joint. The fabella is an accessory ossiclealmost always found in the lateral head of the gastrocnemius, rarely can occur at the medial head of gastrocnemius 4. This includes myoglobinuria in the setting of rhabdomyolysis, which can lead to renal insufficiency, and involvement of respiratory muscles, which can worsen dyspnea related to respiratory failure (22,23). It is important for radiologists to understand the common patterns of COVID-19 involvement in the MSK system, including relevant imaging findings seen with various modalities, as imaging can help identify several MSK manifestations of COVID-19, assess the distribution of disease, and provide quantifiable measurements to follow disease progression. Intravenous contrast material is usually unnecessary. The paranasal sinuses are formed during development by the nasal cavity eroding into the surrounding bones. Sacroiliitis in a 55-year-old man with a history of COVID-192 months earlier and subsequent low back and perianal pain. Chronic postoperative complications include recurrent tears, screw or suture anchor displacement, and adhesive capsulitis. Its principal action is abduction. has provided disclosures (see end of article); all other authors, the editor, and the reviewers have disclosed no relevant relationships. Classic findings of acute venous thrombosis are best diagnosed at gray-scale and color and spectral Doppler US (38). Hip Anatomic Variants That May Mimic Pathologic Entities on MRI: Nonlabral Variants. Contrast extravasation from the arthrogram procedure is also demonstrated. SIRVA is likely related to a localized immunologic reaction to the injectate, and several authors have suggested that this is more common when there has been a prior exposure that sensitizes a patient. The imaging findings of postCOVID-19 inflammatory arthritis are uncommonly reported but are similar to those of viral arthritis from other infections. (A, B) Axial T1-weighted nonfat-suppressed postcontrast MR image of the lumbar spine at the L3 level (A) and sagittal T1-weighted fat-suppressed postcontrast MR image of the lumbar spine through the left neural foramina (B) show thickening and enhancement of the nerve roots (arrows). Common benign tumors involving the shoulder include enchondromas and osteochondromas (Figure 12-27). The signal intensities of MSK hematomas are usually heterogeneous depending on the composition of blood products, without internal enhancement in the absence of an underlying mass (41). While the causes of these conditions are complex and likely multifactorial, some themes have emerged as our understanding evolves. The study group included male patients at the mean age of 34 (17 to 55) years. There is posterior compartment diffuse muscle edema, particularly involving the semimembranosus muscle (dashed arrow). Figure 12-16. If you do not agree to the foregoing terms and conditions, you should not enter this site. Original Author(s): Oliver Jones Last updated: April 1, 2021 Usual and Unusual Musculoskeletal Sequalae of COVID 19! Imaging of the postoperative is challenging due to artifact from surgical hardware.17 Strategies to decrease artifacts include (1) using long echo train fast spin echo sequences rather than gradient sequences, (2) using STIR rather than frequency-selective fat saturation technique, (3) increasing bandwidth, (4) using a high matrix, and (5) frequency encoding away from area of interest. WebNursing Guidance for Postoperative Hip Joint Replacement Patients (Anterolateral Approach) 20 ankle closely touching the bed surface. Sheha et al (17) reported a case of a patient who was discovered to have sickle cell trait after developing ON during COVID-19 infection. The margins are then sutured together. Clustered enlarged axillary lymph nodes, commonly seen following COVID-19 vaccination, are likely reactive and may last for several months (74). Sagittal MRI shows concave undersurface of the acromion consistent with type 2 acromion (black arrow). and Stannard at al. COVID-19related myositis in a 59-year-old nondiabetic woman who presented with burning bilateral foot pain and swelling. Sagittal MRI shows flat undersurface of the anterior lateral acromion consistent with type 1 acromion (black arrow). The infra-spinatus externally rotates the arm. It may affect the shoulder manifesting with synovitis, erosions, and rotator cuff tears. Daniel C. Farber, MD. Normal values for excursion with deep breathing are 47 mm for men and 37 mm for women (67,68). All underwent clinical examination and were included if anterolateral impingement (n = 13) or a control condition (n = 19; suspected osteochondral defect, intraarticular bodies, instability, osteoarthritis) was diagnosed. (2015) Journal of hip preservation surgery. The infraspinatus arises from the infraspinous fossa. Full-thickness tears usually require an open procedure. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-7297. (C) Axial T1-weighted nonfat-suppressed MR image of the mid thighs shows diffuse left thigh muscle atrophy, particularly in the posterior compartment, with more subtle right thigh posterior compartment decreased muscle bulk. The ligamentum teres, also known as theligamentum capitis femorisor round ligament of the hip,is an intra-articular ligament within the medial hip joint. Is our article missing some key information? Finally, multidirectional instability will be discussed. Myonecrosis has several causes, including radiation therapy, diabetes mellitus, immobilization, exercise, medications (eg, statins), and therapeutic ablation (25). Subacromial impingement is initially associated with subacromial/subdeltoid bursitis (Figure 12-8). Coronal oblique MRI shows tears of the coracoclavicular ligaments (white arrow) and disruption and malalignment of the acromioclavicular joint (black arrow). Gross anatomy. PMID: 28321426; PMCID: PMC5347434. Anterior inferior labral tear. In these cases, the presenting symptoms were typical of SIRVA and no other inciting cause was found. 4. Although the precise cause of steroid-induced ON is unknown and probably multifactorial, it likely involves osteoblastic suppression and osteocyte apoptosis, leading to bone resorption, along with the development of microthrombi that result in decreased perfusion and intraosseous adipogenesis. With legs hanging from couch (knee flexion) and knee extension: Dorsiflexion: 0-15 degrees. Ligamentum teres classically is defined as originating from the transverse acetabular ligament. The sagittal plane is acquired parallel to the glenoid articular surface and perpendicular to the long axis of the supraspinatus. It originates anterior to the long head biceps origin and inserts with the coracohumeral ligament to the lesser tuberosity. Less commonly indirect or intravenous arthrography may be performed with an injection of gadolinium at the standard intravenous dose 1020 minutes prior to imaging. GBS in a 15-year-old adolescent girl with COVID-19 with progressive ascending lower extremity pain and weakness. Agarwala et al (16) reported the development of ON in COVID-19 patients with a lower steroid dose and over a shorter time compared with patients without COVID-19. with ankle in neutral dorsiflexion and ~45 degrees internal rotation, take x-rays at 40, 30, 20, and 10 degrees cephalad from neutral. Cortical bone is a potential site of direct infection by SARS-CoV-2 owing to its expression of ACE2 receptors (13). T1-weighted sagittal image optimally depicts advanced muscle atrophy and fatty degeneration around the shoulder including the supraspinatus (black arrow). It ranges from a well-formed structure in some patients to absent in others (see case 2). Anterior or lateral downsloping of the acromion may narrow the acromiohumeral interval and predispose patients to impingement. Os acromiale. Under fluoroscopic guidance, about 12 cc of a 1:200 gadolinium dilution solution is injected into the glenohumeral joint prior to imaging. The patient experienced progressive pain 3 days after her first dose of the vaccine and had no other trauma or prior shoulder injury. On the left, the ossification is well corticated and partially adherent to the posterior glenoid rim (solid arrow), consistent with mild HO. Note the additional enlarged supraclavicular lymph node (dashed arrow). ); Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, N.M. It occurs in ~20% (range 10-30%) of the population 1. 2 (3): 258-64. CHARLES J. SUTRO, MAURICE M. POMERANZ, SYDNEY M. SIMON. These lesions are usually due to repetitive overhead activity or a fall on an outstretched hand (FOOSH) injury. WebAn implant stabilizes two adjacent bones of a joint, while enabling a natural kinematic relative movement of the bones. The cytokine storm is an inflammatory cascade triggered by the virus that causes elevations in many cytokine levels. Proposed mechanisms include corticosteroid administration, hypercoagulability, vascular inflammation (including endothelial inflammation and perivascular leukocyte aggregation), and bone resorption by stimulation of ACE2 receptors (14). (B) More distal axial T2-weighted fat-suppressed MR image of the upper calf shows tibial nerve edema (arrow). Spontaneous intramuscular hematoma resulting in acute muscle denervation from compressive neuropathy in a 60-year-old man with COVID-19 undergoing anticoagulation therapy who presented with left flank pain radiating to the left inguinal region. Magnetic resonance imaging of the Lisfranc ligament. 2022 Radiological Society of North America, Multisystem Imaging Manifestations of COVID-19, Part 1: Viral Pathogenesis and Pulmonary and Vascular System Complications, Assessment of musculoskeletal pain, fatigue and grip strength in hospitalized patients with COVID-19, Musculoskeletal symptoms and related factors in postacute COVID-19 patients, Musculoskeletal involvement of COVID-19: review of imaging, The Society for Immunotherapy of Cancer perspective on regulation of interleukin-6 signaling in COVID-19-related systemic inflammatory response. Reduce the talus in cases of talar dislocation. This chapter is an outline of the basic principles of magnetic resonance imaging (MRI) of the shoulder with an emphasis on the clinical issues related to the imaging findings of shoulder pathology. The anterolateral impingement syndrome is caused by obstruction of the so-called anterolateral gutter (ALG) or recess. Recipient of a Cum Laude award for an education exhibit at the 2021 RSNA Annual Meeting. Compression of motor nerves may result in denervation muscle edema at fluid-sensitive imaging and possibly atrophy at nonfat-suppressed T1-weighted imaging in cases of longer-standing compression (Fig 12). The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. In these cases, fat quantification techniques, such as with Dixon MRI, can provide a measure of muscle atrophy that can aid serial assessment. No significant muscle edema or atrophy is depicted, which suggests that the neuropathy may not extend proximal to the thigh. [2], Anteriorly, the infrapatellar fat pad is inserted below the patella and between the two membranes. Musculoskeletal (MSK) manifestations of COVID-19 are common but have been relatively underreported, possibly because of the severity of manifestations in other organ systems. ON is a well-described condition associated with the original SARS, reported in 5%58% of patients. Reverse Bankart lesion. SARS-CoV-2 has several epitopes that cross-react with host antigens and could result in autoimmune conditions. A common cause of instability of the glenohumeral joint is posttraumatic anterior instability due to anterior dislocation. Edinburgh; Elsevier Churchill Livingstone, c2005. Rotator cuff tendon tears reported in some patients may be preexisting, but the inflammatory response may contribute to symptom development. Thickening of the coracoacromial ligament as part of the coracoacromial arch may cause stenosis of the acromiohumeral interval. A description of a rotator cuff tear should include the portion of the tendon involved (articular, intrasubstance, or bursal); location/size/shape of the defect; and any associated muscle volume loss/fatty degeneration, tendon retraction, or extension into the rotator interval.5 The size of full-thickness defects is given in two dimensions. No space-occupying lesions are depicted along the course of the sciatic nerve. The fabella articulates with its respective (medial or lateral) femoral condyle. The os trigonum (plural: os trigona) is one of the ossicles of the foot and can be mistaken for a fracture. Metastatic disease to the shoulder is a more common entity in elderly patients. (J.S.W., M.S.T. The SICK scapula is in abduction and protraction. 20 (3): 819-36. If the clinical diagnosis is unclear, CT is an excellent initial modality since it can be performed rapidly over large fields of view. Axial T2-weighted fat-suppressed MR image (A) of the right forefoot shows extensive diffuse intrinsic muscle edema, with extensive enhancement seen in the same region on the axial postgadolinium-enhanced T1-weighted fat-suppressed MR image (B). Elevated interleukin 6 (IL-6) levels, in particular, have correlated well with more severe disease (7). In this article, we shall look at the anatomy of the paranasal sinuses their structure, anatomical relations and innervation. Tendinosis of the supraspinatus tendon. It is unclear if there is an association of human leukocyte antigen B27 (HLA-B27) with seronegative spondyloarthropathies that follow COVID-19 (32). Long-standing COVID-19related myopathy can result in muscle weakness, spasms, and exercise intolerance and is associated with decreased muscle bulk and fatty infiltration. No other findings to explain the patients symptoms were seen. (B) More distal axial CT angiographic image of the calves shows near-complete nonopacification of the right popliteal vein with a thin rim of surrounding contrast material (solid arrow), indicating near-occlusive thrombosis. Treatment of these lesions requires decompression of the mass effect on the entrapped nerve. Figure 12-21. Middle glenohumeral ligament. In the elite overhead athlete, repetitive loading of the posterior capsule causes pathologic tightening of the posterior band of the inferior glenohumeral ligament (associated with glenohumeral internal rotation deficit (GIRD) and mineralization of the posterior band described as the Bennett lesion). Figure 12-4. The paranasal sinuses are air-filled extensions of the nasal cavity. These lesions are usually evident at visual inspection without the need for imaging. Figure 2. Diffuse thickening of the superior extensor retinaculum. Other injuries may occur if the needle placement is outside of the safe zone within the deltoid muscle. COVID toes, also known as chilblainlike or perniolike lesions, are localized acral cutaneous erythematous eruptions commonly involving the toes more often than the fingers. Most ankle sprains will heal with standard RICE therapy (rest, ice, compression and elevation) within two to 12 weeks. A recent study showed that critically ill COVID-19 patients were twice as likely to develop a spontaneous iliopsoas hematoma compared with those in the intensive care unit for other reasons (41). In the late cocking/early acceleration phase of the throwing mechanism, the arm is in maximal ABER. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Castro M, Melo L, Canella C et-al. On the right, there is incompletely assessed glenohumeral osteoarthritis with clustered anterior joint recess intra-articular bodies that are separate from the glenoid rim (dashed arrow). superficial: transverse acetabular ligament, posterior attachment: ischial margin of acetabular notch, anterior attachment: pubic margin of acetabular notch, acetabular fossa attachment to the ilium, ischium and pubis. With concurrent nerve injuries, patients may experience numbness, tingling and weakness of the ankle dorsiflexors and great toe extensors, or a footdrop.. It is associated with lesions of the superior labrum, posterior supraspinatus, and superior infraspinatus. Web*A alveolaris inferior[L](inferior alveolar artery) *Aa. They are located laterally and slightly inferiorly to the nasal cavities. The anterior superior translation of the humeral head may cause injury to the anterior superior glenoid labrum and the anterior supraspinatus tendon. The subscapularis is innervated by the subscapular nerve. The coronal plane is acquired along the long axis of the supraspinatus tendon. Summary. Infection of the sinuses causes inflammation (particularly pain and swelling) of the mucosa, and is known as sinusitis. Paralabral cysts may extend into the quadrilateral space demarcated by the teres minor, teres major, humeral shaft, and long head of the triceps. If more than one sinus is affected, it is called pansinusitis. The Geist classification divides these into three types:. (A) Gray-scale US image of the right hemidiaphragm in the ninth intercostal space during the expiratory phase of respiration shows that the zone of apposition of the diaphragm measures 0.18 cm. The inferior and superior portions of the capsule are shifted to overlap each other. They are the most superior of the paranasal sinuses, and are triangular in shape. Figure 3. COVID-19 vaccinerelated findings in three patients. Fig 3 The conchae have been removed, showing the various openings on the lateral wall of the nasal cavity. (B, C) Coronal oblique T2-weighted fat-suppressed (B) and coronal oblique T1-weighted fat-suppressed postcontrast (C) MR images of the same area show bone marrow edema and enhancement in the areas of erosion (arrows), suggestive of active lesions. The cause is likely multifactorial, including immune-mediated damage, intensive care unitacquired weakness, toxic myopathy, and possibly direct viral damage, with certain factors playing a larger role in the development of muscle injury in particular patients. The patient presented with left lower extremity weakness along the sciatic nerve distribution. (A) Coronal T2-weighted fat-suppressed MR image of the shoulder shows typical findings often seen with adhesive capsulitis, including an edematous thickened inferior glenohumeral ligament (IGHL), particularly at its humeral attachment (arrows). Long-axis microvascular Doppler US image of the radial margin of the second MCP joint shows a mildly thickened synovial fluid complex with mild hyperemia (arrow), indicating active synovitis. Grade 4 separation is ACJ and CC ligament disruption along with posterior displacement of the clavicle that may disrupt fibers of the trapezius. Disruption of the biceps pulley may be due to degeneration, acute trauma, or repetitive micro-trauma.6 During adduction and internal rotation, insufficiency of the biceps pulley allows for impingement of the anterior supraspinatus, superior subscapularis tendons, and anterior superior labrum due to compression by the anteriorly/superiorly translated humeral head. ISBN:0443071691. Subacromial/subdeltoid bursitis. Disruption of the biceps pulley mechanism predisposes to abnormal translation of the humeral head. Staphylococcus aureus is the most common causative organism, although unusual organisms like Fusobacterium and Actinomyces species have also been described. Type 2 acromion. The space between the supraspinatus and subscapularis is the rotator interval that contains the coracohumeral and superior glenohumeral ligaments and long head of the biceps tendon. Next, there is a delineation of the disease processes of dead arm, acromioclavicular separation, and pectoralis major rupture. An os subtibiale is a rare, genuine accessory ossicle and normal variant related to the posterior colliculus of the medial malleolus 1. Tension on the superior and medial scapula by the levator scapulae causes a painful tendinopathy. Other mechanisms, such as bystander activation, an antigen-independent stimulation of T cells and/or B cells in sites of inflammation, can also contribute to and exacerbate the autoimmune effects (29). Glossary of terms for musculoskeletal radiology. Additionally, patients with long COVID or those who have been treated or vaccinated can present with MSK symptoms. ABER view for MRI shows there is a tear of the anterior inferior labrum that could only be appreciated on the ABER view consistent with a nondisplaced Perthes type tear (black arrow). Among weight lifters, this lesion is commonly associated with bench press injury. The rotator cuff muscles are dynamic stabilizers of the glenohumeral joint. Webbehind the posterior facet in joint depression fractures. Imaging is used to confirm the diagnosis, location, and extent of macrothrombosis. (2014) RadioGraphics. Ligamentum teres of the hip. (B) Axial CT image (bone window) of the chest at the level of the glenohumeral joints in a 54-year-old man with a history of COVID-19 (hospitalized for 6 weeks) and with left shoulder stiffness shows bilateral periarticular ossifications. Impingement is a clinical diagnosis that may be supported with radiologic findings.3. Figure 4. (2013) American Journal of Roentgenology. All three bones of the pelvis (the ilium, ischium, and pubis) together form the acetabulum.The three bones are initially separated by a Y-shaped triradiate The serum C-reactive protein concentration was elevated to 197 mg/dL, consistent with the inflammatory state, although the serum creatine kinase level remained normal. Case 3: avulsion fracture of femoral head, posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex. (A) Coronal oblique T1-weighted nonfat-suppressed MR image of the sacroiliac joints shows bilateral sacroiliac erosions with irregularity of the subchondral bone plates (arrows) that are more pronounced on the iliac side of the joints. Above, the reflection appears lifted from the bone by underlying periosteal connective tissue. The Neer capsular shift procedure is a glenohumeral joint capsular tightening procedure. 1. MR images may show areas of skeletal muscle and fascial and subcutaneous edema with hyperintense signal with fluid-sensitive sequences and postcontrast enhancement (25) (Fig 5). (C) Sagittal T1-weighted nonfat-suppressed MR image of the same area confirms thickening and ill definition of the coracohumeral ligament (dashed arrow). Unable to process the form. Risk factors include male sex, age greater than 50 years, diabetes mellitus, hypertension, and prolonged intensive care unit stay (53). Web(OBQ06.131) A 14-year-old boy presents 6 months after spraining his right ankle. The diagnosis is made clinically, and imaging may help assess the location and degree of muscle injury. Anterolateral impingement is thought to develop subsequent to a relatively minor injury usually consisting of forced ankle plantar flexion and supination [ 2, 6, 10 ]. This condition is typically monoarticular or oligoarticular and more commonly seen in the lower extremities and in men. (2000). Continuity of the marrow of the exostosis with the central marrow cavity of the humerus is essential in the diagnosis. Complete rotator cuff tear. Although this is likely indirectly due to COVID-19 through prolonged immobilization, diffuse COVID-19related myopathy may also contribute to its development. T1-weighted images are useful for the assessment of bone marrow derangement or rotator cuff atrophy (Figure 12-1). Furthermore, the diaphragmatic excursion with deep breathing is much less than expected. Figure 12-12. Thickenings of the joint capsule are described as the superior, middle, and inferior glenohumeral ligaments. WebThirty-two patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography of the tibiotalar joint. Evaluation of the Tarsometatarsal Joint Using Conventional Radiography, CT, and MR Imaging. Check for errors and try again. (C) Sagittal postcontrast isotropic three-dimensional fast spin-echo STIR reformatted MR image shows the long-axis extent of the sciatic neuropathy from the femoral subtrochanteric level through the popliteal fossa (arrow). (A) Axial T1-weighted nonfat-suppressed MR image of the retroperitoneum shows a heterogeneous left iliopsoas collection (arrow) with a thin peripheral dark rim related to a pseudocapsule and hemosiderin deposition, an inner ring of high signal intensity and a central core of lower signal intensity, related to blood products in various stages (concentric ring sign). Initial MRI findings may be confusing with avidly enhancing extensive soft-tissue edema and distortion. There is a bursal surface tear of the supraspinatus near the myotendinous junction (white arrow). Patients with anterior superior instability due to a biceps pulley injury are predisposed to secondary subcoracoid impingement due to abnormal anterior superior translation of the humeral head. Axial MRI shows fluid and synovitis around the long head of the biceps tendon in the bicipital groove consistent with tenosynovitis (black arrow). COVID-19, a clinical syndrome produced by SARS-CoV-2 infection, has wide-reaching effects throughout the body, including the MSK system. Patients with shoulder impingement typically present with activity-related diffuse pain in the region of the deltoid muscle. The 2023 edition of ICD-10-CM M25.872 became effective on Symptoms may persist or occur months after the initial infection, known as post-COVID condition or long COVID. Between these, the synovial membrane passes in front of the anterior and posterior cruciate ligaments, why these ligaments are both intracapsular and extra-articular with their tibial attachment located exactly on the cartilage margin. The muscle is an internal rotator, flexor, and adductor of the arm. This pyramidal space is formed medially by the tibia, laterally by the fibula, superiorly by the anteroinferior tibiofibular ligament (AITFL), inferiorly by the calcaneofibular ligament and anteriorly by the anterior Therefore, some authors have suggested that the term systemic inflammatory response more accurately describes this phenomenon (8). ); Department of Medical Imaging, Ann & Robert Lurie Childrens Hospital, Chicago, Ill (J.D.S. Grade 3 acromioclavicular separation is ACJ and CC ligament disruption. Hunter, Leonard F. Peltier, Pamela J. Lund. Indeed, the pituitary can be accessed surgically by passing instruments through the sphenoid bone and sinus. MRI is the most sensitive imaging test for detecting sacroiliitis, including symmetric subchondral marrow edema and erosions, particularly in the lower and posterior thirds of the joint (Fig 9). As the global experience with COVID-19 and the vaccination effort increases, certain patterns of MSK disease involving the bones, muscles, peripheral nerves, blood vessels, and joints have emerged, many of which are likely related to a hyperinflammatory host response, prothrombotic state, or therapeutic efforts rather than direct viral toxicity. But for the patients with sprains that do not heal over time with standard therapy, both the cause and next steps for treatment can be unclear.. In this article, we shall look at the anatomy of the paranasal sinuses - their structure, anatomical relations and innervation. 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