Tag Archives: dynamic mri

Dorsal Scapholunate Ligament Tear

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about dynamic mri and ultrasound examination of carpal instability

In my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament I showed the usefulness of both ultrasound and Mri dynamic evaluation in the study of this important ligament structure. Today I want to show you the dorsal scapholunate ligament (SL) tear in a patient that came to my observation after a regular healing of post-traumatic scaphoid fracture.

SL Tear

Coronal Stir (left) and T1w (right)  Mri scans (0.3 Tesla): correct visualization with no artifacts of post-surgical treatment with scaphoid screw. Tear of the dorsal scapholunate ligament is evident (red arrow).

For the appropriate treatment is crucial to see also the dynamic behaviour of this kind of injuries. I always perform both ultrasound and Mri dynamic evaluation in these cases.

The dynamic ultrasound exam shows the post-traumatic carpal instability; dorsal SL tear is evident, togheter with the scapholunate dissociation and DISI picture.

For the correct ultrasound scanning please see my previous post Dynamic Evaluation of Dorsal Scapholunate Ligament.

The Dynamic Mri evaluation (0.3 Tesla) during flexion-extension and ulnar-radial deviation confirms the clinical picture, better defining all the pathologic findings. The radiology technician plays a crucial role for this kind of examination, explaining to the patient the correct wrist movement during the Mri acquisitions.

Haglund’s Syndrome

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About dynamic ultrasound and Mri study of Haglund’s syndrome

Pain at the back of the heel is the clinical presentation of Haglund’s syndrome; Achilles tendinophaty, bony enlargement on posterosuperior aspect of calcaneum and retrocalcaneus bursitis are the main characteristics of this painful syndrome, also associated with calcaneal spurs.  Repetitive impingement microtraumas lead to Achilles tendon degeneration.

I always perform both ultrasound and Mri examinations; direct visualization of the impingement syndrome allows to better estimate the tendon damages and all associated painful conditions, such as the retrocalcaneal bursitis.

Don’t forget to take a look at the Kager’s fat pad triangle; on ultrasound exam its echogenicity need to be the same or inferior than Achilles tendon appearance.

In this patient hyperechogenicity of Kager’s triangle is evident, due to its chronic involvement in the inflammatory process.

haglunds-deformity

From left to right: Sagittal T1w – Xbone T1w and Ge Stir Mri sequences of the same patient (0.3 Tesla).

The Mri exam also shows a stress fracture of the posterosuperior corner of the calcaneus.

The site of impingement is better demonstrated also with the Mri dynamic examination.