The 5th metacarpal pit refers to the normal exaggeration of the pit-like depression in the head of fifth metacarpal.
It should not be mistaken for a fracture (old or new) or an erosion.
Abdominal herniations may be congenital or acquired and come with varying eponyms. They are distinguished primarily based on location and content. 75-80% of all hernias occur in the inguinal region.
Content of the hernia is variable, and may include:
small bowel loops
mobile colon segments (s...
The abdomen, when looking from in front, is divided into nine regions by imaginary planes (two vertical and two horizontal) forming abdominal surface anatomy. The nine regions are of clinical importance when examining and describing pathologies related to the abdomen. The horizontal planes are o...
The abductor digiti minimi muscle overlies the opponens digiti minimi.
pisiform, the pisohamate ligament, and tendon of flexor carpi ulnaris
5th proximal phalanx
abducts 5th finger at metacarpophalangeal joint
The abductor digiti minimi muscle is on the lateral side of the foot and contributes to the large lateral plantar eminence on the sole.
lateral and medial processes of calcaneal tuberosity, and band of connective tissue connecting calcaneus with base of metatarsal V
The abductor hallucis muscle forms the medial margin of the foot and contributes to a soft tissue bulge on the medial side of the sole.
medial process of calcaneal tuberosity
medial side of base of proximal phlanx of great toe
abducts and flexes great to...
The abductor pollicis brevis is a thin subcutaneous muscle laterally placed in the thenar eminence of the hand.
origin: mainly from the flexor retinaculum, few fibres origin from the tubercles of scaphoid and trapezium and tendon of abductor pollicis longus. Accessory slips may spring from the ...
The abductor pollicis longus is a muscle found in the deep posterior compartment of the forearm. As it descends, it becomes superficial and passes under the extensor retinaculum before attaching distally.
origin: posterior surfaces of ulna, radius and interosseous membrane
insertion: via tendo...
The ABER position is related to imaging of the shoulder joint and is a mnemonic for ABduction and External Rotation.
In this position, labral tears are conspicuous by tightening the inferior glenohumeral labroligamentous complex (which are also the most important glenohumeral ligaments in preve...
Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
central core comprised of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessels a...
The absent bow tie sign represents the loss of the normal appearance of the menisci on parasagittal MRI images, and is suggestive of meniscal injury.
Normally the medal and lateral menisci appear as low signal bow-tie-shaped structures between the femoral condyles and tibial plateaux. As the no...
An absent patella is a rare finding and can be found with an equally rare set of associations:
surgical removal of patella (patellectomy)
nail patella syndrome 2
popliteal pterygium syndrome
proximal focal femoral deficiency (PFFD)
Meier-Gorlin syndrome 3
An absent thumb can have many associations. They include:
Fanconi anaemia (pancytopenia-dysmelia syndrome)
phocomelia (e.g. thalidomide embryopathy)
Poland syndrome (pectoral muscle aplasia and syndactyly)
Accessory navicular syndrome occurs when a type II accessory navicular (or "os tibiale externum") becomes painful due to movement across the pseudojoint between the ossicle and the navicular bone.
The syndrome presents on MRI with bone marrow oedema signal (hypointense T1, hyperintens...
The accessory ossicle of the anterior arch of the atlas is a normal variant and is best appreciated on a lateral cervical/sagittal study. It is observed as a circular and corticated osseous density that articulates with the inferior aspect of the anterior arch of the atlas.
It is not associate...
Accessory ossicles are secondary ossification centres that are separate from the adjacent bone. In most cases, they are congenital in origin, although they may occur as a result of trauma or local degenerative disease 2:
shoulder & elbow
os supratrochleare dorsale
Accessory ossicles of the feet are common developmental variants with almost 40 having been described. The more common ones include:
os tibiale externum (accessory navicular)
os calcaneus secundaris
Accessory ossicles of the wrist are commonly seen on plain radiographs of the wrist and associated cross-sectional imaging. Over 20 were originally described 2, although the more common include 1:
lunula: between TFCC and triquetrum
os styloideum (carpal boss): on dorsal surface of 2nd or 3rd ...
Accessory ossicles of the wrist can be easily recalled with the mnemonic:
O: os styloideum (carpal boss)
T: (os) triangulare
T: (os) trapezium secondarium
E: (os) epilunate
O: os hamuli proprium
Accessory peroneal muscles are a group of accessory muscles that can occur in the foot region as a normal variant in some individuals. The peroneal compartment is known as the lateral compartment of the leg.
Peroneus quartus muscle
Originally, several accessory muscles were distinguished in th...
An accessory superior acetabular notch is a normal variant of the acetabulum, which can be seen on radiographs. It may lead to diagnostic confusion, especially in younger patients.
appear as bilateral symmetric fluid-filled pits in the roof of the acetabulum with sh...
The acetabular angle is a radiographic measurement used when evaluating potential developmental dysplasia of the hip (DDH). It is most useful in patients who have started to ossify the epiphysis since ossification diminishes the usefulness of ultrasound.
The angle is formed by a horizontal lin...
The acetabular foramen is formed by the bony margins of the acetabular notch and completed by the transverse ligament of the hip. From its margins (both transverse ligament and acetabular notch) arises the ligamentum teres. Through it pass nutrient vessels to the femoral head epiphysis.
Acetabular labral tears, as the name implies, are tears involving the acetabular labrum of the hip.
With the increasing use of hip arthroscopy in orthopaedic surgery since the 1970s pathologies of the acetabular labrum as a possible cause of chronic hip and groin pain have become more familia...
Acetabular labrum acts to deepen the acetabulum and increase contact between the pelvis and the femoral head. Its exact biomechanical role remains to be fully elucidated.
The acetabular labrum is a C-shaped fibrocartilaginous structure with an opening anteroinferiorly at the site...
The acetablar notch is a depression in the margin of the acetabulum located anteroinferiorly. It is bridged by the transverse ligament, and thus forms the acteabular foramen. The ligamentum teres has part of its origin from the acetabular notch.
A mnemonic to remember causes of acetabular protrusion is:
P: Paget disease
R: rheumatoid arthritis
The acetabulum is the large cup-shaped cavity on the lateral aspect of the pelvis that articulates with the femoral head to form the hip joint.
All three bones of the pelvis (the ilium, ischium, and pubis) together form the acetabulum. The three bones are initially separated by a...
Acheiria refers to absence of one or both hands and can occur in a number of situations, including:
amniotic band syndrome: particularly if unilateral
Cornelia de Lange syndrome 1
fetal hydantoin syndrome 2
Rare defect occurring in 1:65 000 live births.
Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be sen both in athletes and non athletes (weekend warriors). It is difficult to differentiate clinically from a paratend...
Achilles tendon ossification (ATO) is an uncommon condition and has characteristic bone formation within the Achilles tendon itself.
ATO is more common in males 4.
The aetiology is unknown but Achilles tendon ossification is seen both with previous macrotrauma of the...
Achilles tendon tears are the most common ankle tendon injuries, and are most commonly seen secondary to sports-related injury, especially squash and basketball.
There is strong male over-representation presumably as a result of the predominantly sport related aetiology. Patients ...
Achilles tendon thickening can occur for a number of reasons.
The achilles tendon has an average AP diameter of 6 mm 1. Thickening of the tendon is when it exceeds 8 mm in AP diameter and can result from:
Achilles tendon xanthomas are painless soft tissue masses occurring most commonly at the distal one-third of the tendon, usually bilaterally and symmetrically.
It is characterised by localised accumulation of lipid laden macrophages, inflammatory cells and giant cells secondary to ch...
Achondrogenesis refers to a group of rare and extreme skeletal dysplasias.
The estimated incidence is 1:40,000 with no recognised gender predilection.
It is classified as an osteochondrodysplasias, meaning deficiency of both bone and cartilage development.
Achondroplasia is a congenital genetic disorder resulting in rhizomelic dwarfism and is the most common skeletal dysplasia. It has numerous distinctive radiographic features.
It occurs due to sporadic mutations in the majority of cases but can be inherited as an autosomal dominan...
Achondroplasia is the most common cause of short limb dwarfism. (For a general discussion, see the generic article on achondroplasia.)
As the skull base forms by endochondral ossification whereas the skull vault by membranous ossification there is a marked discrepancy in relative size as the sk...
Acro-osteolysis refers to resorption of the distal phalanx. The terminal tuft is most commonly affected but the shaft of the distal phalanx can also be affected in a few conditions. It is associated with a heterogeneous group of pathological entities and, some of which can be remembered by using...
The causes of acro-osteolysis can be remembered using the mnemonic:
I: injury, e.g. thermal burn, frost bite
N: neuropathy. e.g. diabetes, leprosy
C: collagen vascular disease, e.g. scleroderma, Raynaud disease
Acrocephalopolysyndactyly (ACPS) syndrome is comprised of a rare group of disorders collectively characterised by:
calvarial anomalies: e.g. craniosynostoses
digital anomalies: syndactyly and polydactyly
While there can be some overlap in features, they can be primarily classified into the fo...
Acrocephalosyndactyly syndromes (ACS) is a rare group of disorders collectively characterised by:
calvarial anomalies, e.g. craniosynostoses
digital anomalies, e.g. syndactyly
While there can be some overlap in features, they can be primarily classified into the following majo...
Acrodysostosis is a rare skeletal dysplasia characterized by growth retardation, nasal hypoplasia, brachydactyly, midfacial deficiency, mental retardation and deafness.
Most cases are sporadic. Few cases with autosomal dominant transmission have been reported. It is believed to occur...
Acromegaly is the result of excessive growth hormone (GH) production in skeletally mature patients, most commonly from an adenoma of the pituitary.
It most commonly affects adults in middle age and can result in severe disfigurement, serious complicating conditions, and premature death. It has ...
Acromial apohysiolysis is a finding on shoulder MRI that may be encountered in patients with an unfused acromial apophysis. It is associated with athletes in throwing sports.
Presents with superior shoulder tenderness in a patient <25 years old, often in a young throwi...
The shape of the acromion had been initially divided into three types (which was known as the Bigliani classification 3), to which a fourth has been added 2.
This classification was initially proposed by Bigliani et al in 1986 on outlet view radiographs, and later modified by Ki...
Acromioclavicular joint injuries are common and range from a mild sprain to complete disruption of the acromioclavicular joint (ACJ) and injury to surrounding structures.
Acromioclavicular joint injuries usually occur from a direct blow or following a fall onto the should...
The acromioclavicular (AC) joint is a plane synovial joint of the pectoral girdle.
The AC joint is between the small facets of the convex distal clavicle and flat medial acromion. The articular surfaces are lined with hyaline cartilage 4. A wedge-shaped articular disc made from f...
The acromioclavicular (AC) joint radiographic series is a used to evaluate the acromioclavicular joint and the distal clavicle.
AC radiographs are performed for a variety of indications including:
direct blows to the should region
following a fall onto adducted ...
There is much variation in acromioclavicular (AC) joint configuration and should not be confused with pathology.
The relationship of the acromion to the distal clavicle at the AC joint can be described as in the coronal plane 1, 2, 3:
low lying: associated with shoulder im...
Acromiohumeral interval (AHI) is a useful and reliable measurement on AP shoulder radiographs and when narrowed is indicative of rotator cuff tear or tendinopathy.
Measurements of the AHI in the following intervals are suggestive of pathology 1-2:
>12 mm: shoulder dislocation; i...
The acromion, also known as the acromial process, is a small section of the scapula that extends anteriorly from the spinous process.
It forms the acromioclavicular joint with the lateral third of the clavicle, and also connects with the coracoid process via the coraco-acromial ...
Acroparesthesia refers to tingling, pins-and-needles, burning or numbness or stiffness in the hands and feet, particularly the fingers and toes 1. Occasionally episodic pain is also present, which can be very severe 1.
Is one of the more common manifestations of Fabry disease (more common than...
The Adam's forward bend test is clinical test to assess the presence of a scoliosis.
Exclusion of a limb length discrepancy is considered important prior to performing the test. The patient is asked to bend forward with feet together, arms hanging and knees extended until the back be...
Adamantinomas are rare primary malignant bone tumours that in the vast majority of cases occur in the tibia of young patients.
In the past, ameloblastomas, which are benign and locally aggressive bone tumours of the mandible, were also known as adamantinomas of the mandible. Both...
The adductor brevis is a muscle in the thigh that lies immediately deep to the pectineus and adductor longus.
origin: external surface of body of pubis and inferior pubic ramus
insertion: posterior surface of proximal femur, linea aspera, medial supracondylar line
action: adducts and...
The adductor canal is a muscular tunnel in the thigh. It commences at the inferior end of the femoral triangle and terminates at the adductor hiatus.
anteriorly: sartorius muscle
posteromedially: adductor longus and adductor magnus muscles
laterally: vastus mediali...
The adductor hallucis muscle arises by two heads, an oblique and transverse head. It is responsible for adducting the big toe.
transverse head: ligaments associated with metatarsophalangeal joints of lateral three toes
oblique head: bases of metatarsals II to IV and from shea...
The adductor longus is a muscle in the thigh that lies ventral to the adductor magnus.
origin: external surface of body of pubis (triangular depression inferior to pubic crest and lateral to pubic symphysis)
insertion: linea aspera on middle one-third of shaft of femur
The adductor magnus is the largest and deepest of the muscles in the medial compartment of the thigh. Like the adductor longus and brevis muscles, the adductor magnus is a triangular or fan shaped muscle anchored by its apex to the pelvis and attached by its expanded base to the femur.
The adductor pollicis is a large triangular muscle anterior to the plane of the interossei that crosses the palm.
transverse head: 3rd metacarpal
oblique head: capitate and bases of 2nd and 3rd metacarpals II
base of proximal phalanx and extensor hood of thumb
Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a condition characterised by thickening and contraction of the shoulder joint capsule and surrounding synovium. Adhesive capsulitis can rarely affect other sites such as the ankle 8.
The incidence in the genera...
Adventitial bursitis refers to inflammation associated with adventitious bursae.
Adventitious bursae are not permanent bursae and can develop in adulthood at sites where subcutaneous tissue becomes exposed to high pressure and friction, which could then lead to their formation.
Aggressive angiomyxomas are rare pelvic tumours that arise in the pelvis and typically cross the the levator ani muscles. Despite its name, it is essentially a benign tumour and the term "aggressive" is given due to predilection for local recurrence. Only rarely does it metastasise.
Aggressive fibromatosis is a type of musculoskeletal fibromatosis. While it is a non-metastasising fibrous lesion, it is thought to be a true neoplasm that arises from the fascial and musculoaponeurotic coverings, sometimes at the site of a traumatic or post-surgical scar.
Aggressive granulomatosis post hip replacement is a potential complication of a hip joint replacement. Some authors use the same term for particle disease - if you are an expert on this we would love your help.
Aggressive granulomas consist of well organised connective tissue contain...
This classification was proposed by Ahlback et al in 1968.
According to Ahlbäck system knee joint osteoarthritis is classified as:
grade 1: joint space narrowing (less than 3 mm)
grade 2: joint space obliteration
grade 3: minor bone attrition (0-5 mm)
grade 4: moderate bone attrition (5-10 ...
Ainhum ("dactylolysis spontanea") is a rare cutaneous condition in which a hyperkeratotic band partially or totally encircles a digit. The constriction thins the underlying bone, which is then prone to fracture. Some cases result in autoamputation.
Some have suggested th...
This classification was proposed by Allen and Ferguson in 19823 and at the time of writing (July 2016) remains the most widely used system for describing subaxial cervical spine injury.
Allen and Ferguson classification is used for research purposes to classify subaxial spine injuries. It is ba...
Alpha angle can refer to two different musculoskeletal measurements:
alpha angle (developmental dysplasia of the hip)
alpha angle (femoroacetabular impingement)
The alpha angle is a measurement used in ultrasonographic assessment of developmental dysplasia of the hip (DDH).
The angle is formed by the acetabular roof to the vertical cortex of the ilium. This is a similar measurement to the acetabular angle.
The normal value is greater than or equal to ...
Alternating radiolucent and radiodense metaphyseal lines can be seen with a number of conditions and the differential diagnosis is wide:
growth arrest lines
rickets: especially those on prolonged treatment, e.g. vitamin D dependent rickets
Alveolar rhabdomyosarcomas are a type of rhabdomyosarcoma and accounts for 20-40% of all rhabdomyosarcomas 1-2. Unlike embryonal rhabdomyosarcomas, which are more common, these tumours occur in slightly older individuals, typically 10-25 years of age 1.
Although these tumo...
Amniotic band syndrome (ABS) comprises of a wide spectrum of abnormalities which result from entrapment of various fetal parts from a disrupted amnion. Due to the randomness of entrapment, each affected individual has the potential to form a very unique deficit.
The phenomenon is ...
Amphiarthroses are a functional class of joint that permit a small amount of movement under normal conditions.
symphyses (secondary cartilaginous joints)
The term amputation refers to the disconnection of all or part of a limb from the body. Specifically amputation it is defined as removal of the structure through a bone. This is in contrast to disarticulation, which is removal of the structure through a joint.
When due to trauma, t...
Amyloid arthropathy is the extracellular deposition of the fibrous protein amyloid within the skeletal system. It is a skeletal manifestation of amyloidosis and may involve either the axial skeleton (especially the cervical spine) or the appendicular skeleton.
Amyoplasia congenita is a syndrome characterized by multiple specific congenital joint contractures, associated with substitution of muscular tissue by fibrosis and adipose tissue.
The estimated incidence is at 1: 10000 live births. There may be a higher prevalence with twin preg...
The anal sphincter is divided into an internal and external anal sphincter. It surrounds the anal canal.
Internal anal sphincter
continuation of inner rectal muscle
thickened, circular muscle fibres, up to 5 mm thick
composed of visceral muscle
External anal sphincter
An anaplastic rhabdomyosarcoma is a subtype of embryonal rhabdomyosarcoma, characterised by extensive anaplastic cells seen throughout the tumour 1.
The anatomical snuff box is a surface anatomy feature. It appears as a triangular depression on the lateral surface of the wrist on full extension of the thumb.
medial – extensor pollicis longus
lateral – extensor pollicis brevis and more laterally abductor pollicis longus
The anconeus is a small muscle in the posterior compartment of the arm at the lateral aspect of the elbow. It has little functional significance but should be differentiated from the variably present anconeus epitrochlearis at the medial aspect of the elbow.
origin: lateral epicondyle ...
Anconeus epitrochlearis is an accessory muscle at the medial aspect of the elbow. It is also known as the accessory anconeus muscle and should not be confused with the anconeus muscle which is present at the lateral aspect of the elbow.
The muscle may be unilateral but has been f...
Andersson lesions refer to inflammatory involvement of the intervertebral discs by spondyloarthritis.
Rheumatic spondylodiscitis is a non-infectious condition that has been shown to occur in about 8% of patients with ankylosing spondylitis, as detected at radiography.
Aneurysmal bone cysts (ABC) are benign expansile tumour-like bone lesions of uncertain aetiology, composed of numerous blood filled channels, and mostly diagnosed in children and adolescents.
Aneurysmal bone cysts are primarily seen in children and adolescents, with 80% occurring...
Angiolipomas (also sometimes known as haemangiolipomas, vascular lipomas, and fibromyolipomas) are rare soft tissue tumours composed of mature adipocytes and vessels. They can occur essentially anywhere, and can be subclassified into infiltrating and non-infiltrating varieties 1.
The most comm...
Angiosarcoma of bone is a malignant vascular tumour of bone. These are rare and account for less than 1% of malignant bone tumours. The majority of these tumours arising in bone are primary; however, a tiny percentage is either radiation-induced or associated with bone infarction
The angle of the longitudinal arch is one of the angles drawn on the weightbearing lateral foot radiograph. The angle is formed between the calcaneal inclination axis and a line drawn along the inferior edge of the 5th metatarsal.
The normal angle is 150-170 degrees.
In pes cavus, as the heigh...
Anisotropy is an artifact encountered in ultrasound, notably in muscles and tendons during musculoskeletal ultrasound. In musculoskeletal applications, the artifact may prompt an incorrect diagnosis of tendinosis or tendon tear.
When the ultrasound beam is incident on a fibrillar structure as a...
Ankle fractures account for ~10% of fractures encountered in trauma, preceded only in incidence by proximal femoral fractures in the lower limb. They have a bimodal presentation, involving young males and older females. Ankle injuries play a major part in post multitrauma functional impairment t...
The ankle radiograph checklist is just one of the many pathology checklists that can be used when reporting to ensure that you always actively exclude pathology that is commonly missed; this is particularly helpful in the examination setting, e.g. the FRCR 2B rapid-reporting.
The ankle series is comprised of an anteroposterior (AP), mortise and lateral radiograph. The series is often used in emergency departments to evaluate the distal tibia, distal fibula, and the talus; forming the ankle joint.
See approach to an ankle series.
Ankle radiographs are p...
Ankle tear drop sign is one of the radiological signs of an ankle joint effusion. It represents the presence of fluid in the inferior part of anterior compartment of ankle .
Ankle AP mortise view is part of a three view series of the distal tibia, distal fibula, proximal talus and proximal metatarsals. It is the most pertinent projection to asses the articulation of the tibial plafond and two malleoli with the talar dome otherwise know as the mortise joint of the an...