1. MT S PHN TN THNG C XNG KHP CHI TRN V CHI DI Dr Le Duy Chung

2. Shoulder Elbow Wrist and Hand Upper extremity 3. Type I Type II Type III Type IV Type 1: flat undersurface Type 2: curved undersurface Type 3: hooked Type 4: upward or superior convexity of inferior border Contemp Orthop. 1995 Mar;30(3):227-9. Acromion Shape 4. flat lateral tilt low-lying Acromion Slope 5. Os Acromiale 6. Os Acromiale 7. Crescentic U-shaped L-shaped Supraspinatus Tear Shape 8. Partial-Thickness Tear Bursal surface Partial-thickness tear with tendon thinning Articular surface Intrasubstance 9. Ellmans grade Grade 1: < 3mm Grade 2: 3-6mm, < 50% of cuff thickness Grade 3: > 6mm, > 50% of cuff thickness Clin Orthop Relat Res. 1990 May;(254):64-74. Partial-Thickness Tear : Depth 10. Greatest dimension of tear Small : < 1 cm Medium : 1~3 cm Large : 3~5 cm Massive : > 5 cm Full-Thickness Tear 11. Small: < 1cm Medium: 1-3 cm Large: 3-5 cm Massive : >5cm 12. Tendon Retraction Stage 1 Stage 2 Stage 3 Irreparable if retracted tendon edge is medial to glenoid fossa ! Full-Thickness Tear 13. Grade 0 normal Pfirrmann CWA et al . Radiology 1999; 213: 709-714 Subscapularis Tendon Tears Grading Grade 1 cranial lesion Grade 2 cranial three- quarters tears Grade 3 complete tear 14. Impingement : Classification Type 1 Presence of subacromial bursitis Type 2 Tendinosis (type 2a), Partial tear (type 2b) Type 3 Complete tear of RC AJR Am J Roentgenol. 1988 Feb;150(2):343-7. 15. Impingement : Classification 16. Goutallier classification is used for the assessment muscle degeneration: Grade 0: No intramuscular fat Grade 1: Some fatty streaks Grade 2: Fat is evident but less fat than muscle tissue Grade 3: Fat equals muscle tissue Grade 4: More fat is present than muscle tissue References Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;78-83 Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999; 8(6):599-605 Goutallier Classification 17. I II IV III V Goutallier Classification 18. normal atrophy Tangent Sign Muscle Atrophy Oblique sagittal at medial coracoid process Scapular Ratio < 50%, atrophy 19. Current SLAP Lesion Classification with Associated Clinical Findings and Mechanisms of Injury I Fraying Could be incidental finding; more significant in young people involved in overhead activities II Tear with biceps extension Most common type; association with acute traction, repetitive overhead motion, and microinstability; could be associated with type IV III Bucket-handle tear with intact biceps Less severe than type IV; association with fall on outstretched arm IV Bucket-handle tear with biceps extension More severe than type III because of biceps extension; could be associated with type II; association with fall on outstretched arm. V Not specified Either a Bankart lesion with superior extension or a SLAP lesion with anterior inferior extension VI Anterior or posterior flap tear Probably represents type IV or less likely type III with tear of the bucket-handle component VII Not specified Type of middle glenohumeral ligament extension (avulsion or split) not specified; association with acute trauma with anterior dislocation VIII Not specified Similar to type IIB but with more extensive abnormalities; association with acute trauma with posterior dislocation IX Not specified Global labrum abnormality; probably traumatic event X Not specified +Rotator interval extension; articular side abnormalities 20. I Fraying II Tear III Bucket handle tear IV Biceps tendon V Bankart Fraying VI Flap VII MGHL VIII Posterior IX AnteriorPosterior X RCI SLAP lesion 21. SLAP lesion 22. Smith et al. Radiology 201:251256 Eur Radiol. 2006 Feb;16(2):451-8 Superior sublabral recess : Types 23. Superior sublabral recess. Drawings representing a coronal section through the labral- bicipital complex illustrate type I (1), type II (2), and type III (3) labral attachments. In type I, the labrum (L) is tightly attached to the glenoid, whereas in types II and III, a recess is present between the labrum and glenoid (arrow). B = biceps tendon, C = cartilage. De Maeseneer, M. et al. Radiographics 2000;20:67-81S Superior sublabral recess : Types 24. Zlatkin MB, et al. AJR;1988: 150: 151-158 From glenoid labrum From glenoid neck, < 1cm From glenoid neck, > 1cm Capsular insertion : Types 25. Type IIType I Type III Zlatkin MB, et al. AJR;1988: 150: 151-158 Capsular insertion : Types 26. Habermyer classification of biceps pulley lesions J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):5-12. Group 1 Group 4Group 3 Group 2 27. Formation phase Resting phase No enlargement of deposit Resorptive phase Inflammation with cells resolving calcium Post-calcific phase Reconstruction of tendon integrity Calcific tendinitis : Stages 28. Shoulder Elbow Wrist and Hand Upper extremity 29. Stage 1 PLRI of ulna and radius Disruption of LUCL RCL & post-lat capsule Stage 2 Incomplete dislocation Coronoid appears perched on the trochlea Lateral ligaments and capsular disruption Stage 3 complete posterior dislocation 3A: only posterior bundle of MCL disruption 3B: anterior bundle of MCL disruption Clin Orthop Relat Res 2000(370):34-43 Elbow instability : Stages (posterolateral rotatory instability PLRI) 30. Clin Orthop Relat Res 2000(370):34-43 Elbow instability : Stages 31. Shoulder Elbow Wrist and Hand Upper extremity 32. Distal radioulnar joint dislocation 33. TFCC lesions by Palmer 34. I: traumatic injury A: central perforation B: ulnar avulsion distal ulnar fracture C: distal avulsion (carpal attachment) D: radial avulsion sigmoid notch fracture TFCC lesions by Palmer 35. I A I B TFCC lesions by Palmer B: ulnar avulsion distal ulnar fracture A: central perforation 36. I D I C TFCC lesions by Palmer C: distal avulsion (carpal attachment) D: radial avulsion sigmoid notch fracture 37. II; degenerative injury A: TFC complex wear B: A + chondromalacia (lunate or ulnar) C: TFCC perforation + chondromalacia D: C + lunotriquetral ligament perforation E: D + ulnocarpal osteoarthritis TFCC lesions by Palmer 38. IIA IIB TFCC lesions by Palmer A: TFC complex wear B: A + chondromalacia (lunate or ulnar) 39. IIEIIDIIC TFCC lesions by Palmer C: TFCC perforation + chondromalacia D: C + lunotriquetral ligament perforation E: D + ulnocarpal osteoarthritis 40. extensor carpi ulnaris tendon 41. Hip Knee Ankle and Foot Lower extremity 42. Ficat RP, JBJS(B) 1985: 67:3-9 Stage Radiographic Appearance RN uptake 0 Normal Normal I Normal Decrease II Increased sclerosis Increased IIIa Increased sclerosis, subchondral fracture without collapse Increased IIIb Increased sclerosis, subchondral fracture with collapse Increased IV Increased sclerosis, subchondral fracture with collapse and secondary osteoarthritis Increased Osteonecrosis Staging Ficat stages 43. Osteonecrosis Staging Association Research Circulation Osseous (ARCO) 0 Normal I Medullar edema, joint effusion II Necrosis, demarcation III Microfracture IV Flattening head V Joint space narrowing, acetabular VI Joint destruction 44. Criteria for staging AVN ______________________________________________________________________________________ Stage ______________________________________________________________________________________ 0 Normal or non-diagnostic radiograph, bone scan and MRI I* Normal radiograph, abnormal bone scan and/or MRI II* Abnormal radiograph showing `cystic' and sclerotic changes in the femoral head III* Subchondral collapse producing a crescent sign IV* Flattening of the femoral head V* Joint narrowing with or without acetabular involvement VI Advanced degenerative changes ______________________________________________________________________________________ Quantification of extent of involvement by AVN __________________________________________________________________________________________ Stage Grade __________________________________________________________________________________________ I and II A, mild 30% III A, mild subchondral collapse (crescent) beneath 30% IV A, mild 4 mm depression V A, B or C average of femoral head involvement, as determined in stage IV, and estimated acetabular involvement __________________________________________________________________________________________ Steinberg ME et al. JBJS(B) 1995: 77 (1);34-41 Steinberg Staging 45. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995;77(1):3441 RadioGraphics 2007;27:1005-1021 Osteonecrosis staging University of Pennsylvania System for Staging Avascular Necrosis of the Hip Stage Imaging Criteria 0 Normal or nondiagnostic radiographs, bone scans, and MR images I Normal radiographs, abnormal bone scans and MR images II Abnormal radiograph showing cystic and sclerotic changes in the femoral head III Subchondral collapse producing a crescent sign IV Flattening of the femoral head V Join narrowing with or without acetabular involvement VI Advanced degenerative changes 46. % of necrotic lesion = (A/180)x(B/180)x100 47. Mitchell Staging System 48. Acetabular labral lesions Czerny classification Stage 0 Homogeneous low SI, triangular shape, continuous attachment to lateral margin of acetabulum without notch or sulcus (normal) 1A Area of increased SI within the center of triangular shaped labrum 1B 1A + thickened labrum, no labral recess 2A Extension of contrast material into labrum without detachment from acetabulum. Triangular shape and labral recess is present 2B 2A + thickened labrum, no labral recess 3A Detached labrum from acetabulum. Triangular shape and labral recess is present 3B 3A + thickened labrum, no labral recess Czerny C, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996;200:225-230 49. Hip Knee Ankle and Foot Lower extremity 50. Medial patellar plica Sakakibara Arthroscopic Classification Type A: cordlike elevation in synovial wall Type B: shelflike appearance but not cover anterior surface of medial femoral condyle Type C: large with shelflike appearance and cover anterior surface of medial femoral condyle Type D: central defect (fenestrated plica) Basis of size AJR 2001; 177:221-227 Sakakibara J. Arthroscopic study on Iino's band. Nippon Seikeigeka Gakkai Zasshi 1976;50:513 -522 51. Suprapatellar plica Zidorn classification Type I (septum completum) suprapatellar bursa and knee joint are completely separated by septum Type II (septum perforatum) one or more openings of varying size in septum Type III (septum residuale) remaining fold, usually in medial location Type IV (septum extinctum) completely involuted septum 52. Outerbridge Classification Grade 0: intact cartilage with normal signal and uniform thickness Grade 1 : thickening with abnormal signal Grade 2 : superficial ulceration or fissuring Grade 3 : deep ulceration or fissuring Grade 4 : full-thickness chondral injury with bruising of subchondral bone Grade 5 : osteochondral injury with separation of osteochondral fragment 53. Cartilage lesions Outerbridge and Yulish Classification Yulish BS, Montanez J, Goodfellow DB, Bryan PJ, Mulopulos GP, Modic T. Chondromalacia patellae: assessment with MR imaging. Radiology 1987;156:763-766 Arthroscopic (Outerbridge) classification MR (Yulish) classification Grade 0 Normal Grade 0 Normal Grade 1 Softening, without morphologic defect Grade 1 Normal contour abnormal signal Grade 2 Superficial blistering or fraying: erosion or ulceration of 50%, but 50%, but