A number of processes can affect tendons.
Literally means a disease or disorder of a tendon and typically used to describe any problem involving a tendon. While many define tendinopathy as an umbrella term to describe all tendon pathology, others may use it to descr...
Mnemonics for remembering the three conjoined tendons that make up the pes anserinus include:
Say Grace before Tea
From anterior to posterior, the tendons are:
Say Grace before Tea
Tennis leg represents a myofascial or tendinous injury of the lower limb and, not surprisingly, is seen most frequently in tennis players.
Although classically seen in people who play tennis, it can also be induced by playing squash, skiing, and athletics. Therefore, it typically ...
Tenosynovitis is a term describing the inflammation of the synovial membrane surrounding a tendon. The synovial membrane is part of a fluid-filled sheath that surrounds a tendon.
pain in the affected area and pain moving a joint
reddening along the length...
The tensor fasciae latae muscle is the most anterior of the superficial group of muscles in the gluteal region and overlies the gluteus minimus and the anterior part of the gluteus medius.
origin: lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of cr...
The tensor fasciae suralis muscle is an uncommon accessory muscle in the popliteal fossa. It can be an unusual cause of a popliteal fossa soft-tissue swelling or mass.
origin: may arise from the distal aspect of any of the hamstring muscles, in the majority of reported cases it origin...
Teres major is one of the seven scapulohumeral muscles that act around the glenohumeral joint to facilitate shoulder movement.
origin: caudal two thirds of lateral border and inferior angle of scapula
insertion: medial border of the intertubercular groove, which is the crest of lesser...
Teres minor is one of the four muscles that make up the rotator cuff, the others being: supraspinatus, infraspinatus, and subscapularis.
origin: lateral border of the scapula
insertion: greater tuberosity of the humerus
innervation: axillary nerve (C5-6)
arterial supply: circumflex ...
The terminal tuft is the most distal part of a distal phalanx, and comprises of the flared bone distal to the shaft.
spade phalanx sign
terminal tuft masses
as it is close to the nail, pathology or injuries of one can affect the other
There is only a short list of terminal tuft masses, which can arise from the adjacent soft tissues and erode the terminal tuft as well as arising from the terminal tuft itself:
epidermal inclusion cyst: history of penetrating trauma
giant cell tumour of the tendon sheath: occur laterally
The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.
Most commonly due to a fall onto an outstretched hand, not necessarily high-energy, with the arm in semi-flexion and supination...
The Terry Thomas sign refers to an increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. There is no consensus as to what measureme...
Thalassaemia is an autosomal recessive haemoglobinopathy that originated in the Mediterranean region. The genetic defect causes a reduction in the rate of globin chain synthesis which causes the formation of abnormal haemoglobin molecules. The resultant microcytic anaemia is the characteristic p...
Thalidomide embryopathy refers to a syndrome resulting from in utero exposure to thalidomide, and is characterized by multiple fetal anomalies. Fetal exposure to thalidomide occurred primarily from 1957 to 1961, when it was used as a treatment for nausea in pregnant women.
Thanatophoric dysplasia (TD) is a lethal skeletal dysplasia. It is the most common lethal skeletal dysplasia followed by osteogenesis imperfecta type II.
The estimated incidence is around 1:25,000-50,000 3.
It results from a mutation coding for the fibroblas...
Thiemann disease (also called familial osteoarthropathy of the fingers or osteonecrosis of the base of phalanx) is a non-inflammatory disorder of unknown aetiology and refers to osteonecrosis of the epiphyses of phalanges which leads to deformity of fingers.
Thiemann disease is a ...
Thigh refers to the portion of the lower limb between the hip and knee joints. Note that in an anatomical context "leg" refers to the portion between the knee and ankle joints and not to the entire lower limb.
The third condyle (also known as condylus tertius or median occipital condyle) is a rare anatomic variant of the occipital condyles. It is a small separate ossicle at the anteromedial margin of the occipital condyle formed by the failure of the embryonic proatlas (4th occipital sclerotome) to un...
The thoracic spine forms the middle part of the vertebral column. It extends from below C7 on the cervical spine to above L1 on the lumbar spine. There are 12 thoracic vertebra, termed T1-T12 (some older doctors and texts refer to the dorsal spine and D1-D12).
The thoracic spine is unique due ...
The thoracic spine AP view images the thoracic spine, which consists of twelve vertebrae. It is utilised in many imaging contexts including trauma, postoperatively, and for chronic conditions.
the patient is erect or supine, depending on clinical history
ideally, spinal imag...
The thoracic spine lateral view images the thoracic spine, which consists of twelve vertebrae. It is utilised in many imaging contexts including trauma, postoperatively, and for chronic conditions. It is used in conjunction with the thoracic spine AP view to complete a thoracic spine series.
The thoracic spine series is comprised of two standard projections along with a range of additional projections depending on clinical indications. The series is often utilised in the context of trauma, postoperative imaging and for chronic conditions.
Radiographs of the thoracic spine are consi...
The thoracoacromial artery is a vessel arising from the axillary artery at the axilla.
origin: first branch of the second part of the axillary artery 1
supply: pectoralis major and minor, anterior part of the deltoid, and dermal sensation overlying the clavipectoral ...
The thoracodorsal nerve also known as the middle subscapular or long subscapular nerve arises from the posterior cord of the brachial plexus and supplies the latissimus dorsi muscle.
The thoracodorsal nerve arises from the posterior cord of the brachial plexus with fibres...
The thoracoepigastric vein provides a communication between the superficial epigastric vein and the lateral thoracic vein as it ascends superficially on anterolateral chest and abdominal wall. It, therefore, drains into both the superior vena cava via the axillary vein and the inferior vena cava...
The thoracolumbar injury classification and severity score (TLICS), also sometimes known as the thoracolumbar injury severity score (TISS), was developed by the Spine Trauma Group in 2005 to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture clas...
The two most commonly currently used thoracolumbar spinal fracture classification systems are the AO classification and the TLICS although a number of other classification systems have been proposed over the years 1. Each has benefits and drawbacks and each incorporates various features in an at...
The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.
While initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as...
Throckmorton sign, also known as John Thomas sign, refers to when the penis points in the direction of unilateral disease, typically of the pelvis or hip.
Throckmorton sign is a slang term used humorously by medical students and residents.
According to the first serious study of the sign publ...
The thumb AP (anteroposterior) view is one of the standard views for assessment of the thumb. The PA (posteroanterior) view can be utilised when the patient is unable to achieve the position required for the AP view. They are one part of the three view thumb series.
There will be some magnific...
The thumb lateral view is an orthogonal projection of AP/PA view and helps in the localisation of a foreign body in the thenar eminence, as well as providing valuable information of suspected dislocations.
patient is seated alongside the table
the forearm is placed on table
The thumb oblique view is a part of the thumb series and is particularly useful in cases with traumatic indications.
patient is seated alongside the table
forearm is placed on table
the wrist is kept in ulnar deviation and thumb abducted
fingers are kept in contact with the...
The thumb series is comprised of a posteroanterior and oblique, projection. The posteroanterior projection is interchangeably performed anterioposter or posteroanterior depending on mobility. It examines in detail the first metacarpal and its articulations. Thumbs have a vital impact in our day ...
This is a basic article for medical students and other non-radiologists
A thumb series (or thumb x-ray) is usually performed in the Emergency Department or Orthopaedic service following thumb trauma with suspected fracture or dislocation.
This is a summary article. For more ...
The Thurstan Holland fragment also known as the Thurstan Holland sign is an eponymous radiological sign depicting a triangular portion of the metaphysis remaining with the epiphysis in a physeal fracture. This fragment is one of the tell-tale signs of a type 2 Salter-Harris fracture 1.
Thyroid acropachy is an unusual presentation of autoimmune thyroid disease, (~1% of patients with Graves disease). It can occur in hyperthyroid, euthyroid, hypothyroid, or even post-treatment patients. It is almost always associated with thyroid ophthalmopathy.
The majority of pa...
This is a basic article for medical students and other non-radiologists
A tib/fib x-ray, also known as tib/fib series or tib/fib radiograph, is a set of two x-rays of the leg (knee to ankle). It is performed to look for evidence of injury (or pathology) affecting the leg, often after trauma.
The tibia (plural: tibiae) is the largest bone of the leg and contributes to the knee and ankle joints. (shin- or shank-bone are lay terms). It is medial to and much stronger than the fibula, exceeded in length only by the femur.
The tibia has a prismoid shaft, expande...
The tibia fibula AP view is part of a two view series of the entire tibia, fibula, and both the knee and ankle joint.
the patient may be supine or sitting upright with their leg straighten on the table
the foot is in dorsiflexion
the toes will be pointing directly toward th...
The tibia fibula lateral view is part of a two view series of the entire tibia, fibula, and both the knee and ankle joint.
the patient is in a lateral recumbent position on the table
the lateral aspect of the knee and ankle joint should be in contact with the table resulting...
The tibia/fibula is comprised of an anteroposterior (AP), and lateral radiograph. The series is often used in emergency departments to evaluate the entirety of the tibia and fibula after trauma.
The tibia/fibula radiographs are performed for a variety of indications including:
Tibial hemimelia or tibial deficiency is an uncommon abnormality which can range from isolated mild shortening to complete tibial absence 1.
Tibial hemimelia is extremely rare, occurring in only one out of one million live births 2.
The affected limb is sho...
The tibialis anterior muscle is one of the muscles of the anterior compartment of the leg involved in dorsiflexion and inversion of the foot.
origin: body of the tibia
insertion: medial cuneiform and first metatarsal
action: dorsiflexion and inversion of the foot
arterial supply: an...
The tibialis posterior muscle is one of the small muscles of the deep posterior compartment of the leg.
origin: inner posterior borders of the tibia and fibula
insertion: navicular and medial cuneiform
the tendon splits into two slips after passing inferior to plantar calcaneonavicu...
The tibial nerve is one of two terminal branches of the sciatic nerve and supplies the leg and foot with motor and sensory supply.
origin: the terminal branch of sciatic, at or above the popliteal fossa
course: courses straight down the popliteal fossa, passing deep to gastrocnemius t...
The tibial plateau is the proximal articular surface of the tibia.
The tibial plateau is composed of two parts:
concave articular surfaces of the oval-shaped medial and circular-shaped lateral tibial condyles (medial and lateral tibial plateaus)
the medial tibial plateau is lar...
Tibial plateau fractures were originally termed a bumper or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers.
The most common mechanism of injury involves axial loading, e.g. fall from a significant height. In younger patients, the m...
Tibial tuberosity avulsion fractures are uncommon and usually associated with sports activities that require jumping. Avulsion occurs with the violent active extension of the knee or passive flexion against contracted quadriceps muscles.
Although an acute injury, tibial tuberosity avulsion is m...
Tibial tuberosity transfer is surgical procedure performed for patella instability. Tibial tuberosity transfer can simultaneously correct a high-riding patella. The goal of the surgery is often to transfer the distal attachment of the patellar tendon, thereby shifting the force vector medially a...
Tibia vara (also known as genu varus and bow-leggedness) is a varus deformity with outward bowing at the knee and medial angulation (inward) of the lower leg in relation to the thigh's coronal axis.
The differential of bow-legging in children is long, with common causes including Blount disease...
The tibiofemoral joint is a modified hinge synovial joint between the distal femur and the proximal tibia.
articulation: modified hinge joint between the medial and lateral condyles of the femur and the tibial condyles
ligaments: transverse ligament of the knee, medial an...
Tibiotalar slant is the superolateral inclination of the tibial plafond, and results in an ankle valgus deformity. There are a number of causes 1:
trauma, i.e. distal tibial fractures
osteomyelitis and/or septic arthritis
juvenile idiopathic arthritis
sickle cell dis...
Tietze syndrome refers to a benign costochondritis accompanied by hypertrophy of the costal cartilages.
The exact incidence of occurrence is not known. It is seen most commonly in the 2nd to 5th decades of life. Both sexes are affected equally.
It is characterised as a...
Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.
It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.
The Tinel sign refers to distal paresthesia which is induced by percussion over the affected portion of an entrapped nerve.
It is particularly useful in the diagnosis of entrapment syndromes:
carpal tunnel syndrome
tarsal tunnel syndrome
Toddler fractures are minimally or undisplaced spiral fractures usually of the tibia, typically encountered in (you guessed it) toddlers. It is a potentially difficult diagnosis to establish on account of both the symptoms and imaging findings being subtle.
The term has sometimes a...
Toes AP view is part of a three view toe series and includes the phalanges and the toe(s) of interest and the distal half of the associated metacarpals.
the patient can be either supine or be sitting upright on the table
knee should be flexed so the plantar surface of the foo...
The toes series is comprised of an AP, AP oblique, and a lateral projection. The series is often utilised in trauma situations. It examines the entirety of the proximal middle and distal phalanges of the foot.
Toe radiographs are performed for a variety of indications including 1:...
Tombstone iliac wings, also referred to as Mickey Mouse ears pelvis 1, are an imaging descriptor for the iliac wings of individuals with achondroplasia. These are seen to be small and squared and have been likened to the appearance of tombstones or the ears of Mickey Mouse.
Tooth-knuckle injuries are sustained when the clenched fist of a patient strikes the teeth of an opponent.
Tooth-knuckle injuries are also referred to as clenched fist injuries, closed fist injuries and fight bite injuries.
These injuries are most commonly found in y...
The toothpaste sign in spinal imaging represents an extrusion of an intervertebral disc into the epidural space. It is called after the shape of extruded material relatively to the parent disc in a sagittal plane.
Tophi (plural of tophus) appear as lumps on affected joints due to deposits of monosodium urate (MSU) crystals in patients with longstanding high levels of serum uric acid (hyperuricaemia).
Tophi are a pathognomonic feature of gout.
History and etymology
Tophus means "stone" in Latin.
Torg's classification of proximal fifth metatarsal fractures is based on the degree of sclerosis adjacent to the fracture on imaging at the time of presentation to determine the fracture age.
narrow fracture line with sharp margins and no widening
minimal cortical hyper...
Torticollis (wryneck) is a clinical finding of head tilt with or without rotational spinal malalignment. It is not a diagnosis in itself and there are a wide range of underlying conditions. It is most common in the paediatric age group.
Torticollis can be acute (<1 week) or chronic ...
Torus fractures, also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterised by bulging of the cortex. They result from trabecular compression from an axial loading force along the long axis of the bone. They are usually seen in children, frequently...
Total hip arthroplasty (THA) or total hip replacement (THR) is an orthopaedic procedure which involves the surgical excision of the femoral head and cartilage of the acetabulum and replacement of the joint with articulating femoral and acetabular components. It is a commonly performed procedure ...
Total knee arthroplasty (TKA), or total knee replacement (TKR), is an orthopaedic procedure whereby the three articular surfaces of the knee (femoral, tibial, and patellar) are replaced by prosthetic components.
TKA is the most common joint arthroplasty performed in the United States, with an e...
Total talar dislocation, also known as extrusion of the talus, is a tri-articular dislocation of talus at the tibiotalar, talonavicular and subtalar joints. Most injuries are compound.
Mechanism of injury
Total talar dislocation is a rare injury caused by the combination of tibiotal...
Trabecular pattern of proximal femur refers to the five groups of trabeculae that are demonstrable within the femoral head and neck.
Trabecula is a supportive and connective tissue element which form in cancellous bone. Trabeculae develop in a normal bone and also in a healing bo...
Trampoline fractures are transverse fractures of the proximal tibial metaphysis that occur in children while jumping on a trampoline (or inflatable castle).
The fracture is thought to occur when a second, usually heavier individual causes the jumping surface to recoil upwards as the unsuspectin...
Tramp-stamp oedema is a colloquial term used by some radiologists to denote posterior lumbar subcutaneous oedema. The term is used to describe oedema in the distribution seen with lower back tattoos, usually in young women, which are known pejoratively as tramp-stamps.
This oedema is thought t...
Transient synovitis of the hip refers to a self-limiting acute inflammatory condition affecting the synovial lining of the hip. It is considered one of the most common causes of hip pain and limping in young children. Over 90% of hip joint effusions in children tend to be due to transient synovi...
Transitional vertebra is one that has indeterminate characteristic and features of vertebrae from adjacent vertebral segments. They occur at the junction between spinal morphological segments:
atlanto-occipital assimilation: complete or partial fusion of C1 and the o...
Transversalis fascia is the lining fascia of the anterolateral abdominal wall which lies between the transversus abdominis muscle and peritoneum.
The transversalis fascia, inferior diaphragmatic fascia, pelvic fascia and iliacus fascia form a continuous lining of the abdominal a...
The transverse acetabular ligament is part of the labrum but has no cartilage cells. Its strong, flat fibres cross the acetabular notch forming a foramen through which vessels and nerves enter the joint.
The transverse arch of the foot is an arch in the coronal plane formed by the three cuneiforms, the cuboid, and the bases of the five metatarsals. They are held together by the deep transverse metatarsal ligaments. The peroneus longus and tibialis posterior tendons assist in maintaining the curv...
Transverse fractures are complete fractures that traverse the bone perpendicular to the axis of the bone. The fracture involves the cortex circumferentially and there may be displacement.
The term is predominantly used in the context of fractures of long bones although other types of bones may ...
The transverse ligament of the hip bridges the acetabular notch (located anteroinferiorly along the margin of the acetabulum) and joins the two ends of the acetabular labrum, thus forming a complete ring. Beneath it (through the acetabular foramen) pass nutrient vessels which enter the ligamentu...
The transverse ligament of the knee is a ligament within the anterior aspect of the knee joint.
The transverse ligament is a variable band-like intracapsular knee ligament. It attaches transversely across the anterior aspects of the convex margins of the medial and lateral menisci.
Common causes of transverse metaphyseal lines can be remembered using the mnemonic:
D: D-vitamin intoxication
E: elemental arsenic and heavy metals (lead, bismuth, phosphorus)
N: normal variation
S: systemic illness
E: estrogen to mother during p...
Transverse process fractures are a common sequelae of trauma, although they are considered a minor and stable lumbar spine fracture. There is strong association between transverse process fractures and other traumatic injuries.
Transverse process fracture most commonly occur in the u...
Transplantation of a transverse rectus abdominis myocutaneous (TRAM) flap is a commonly used surgical procedure for breast reconstruction following mastectomy.
An autologous myocutaneous flap consisting of abdominal skin, subcutaneous fat, the rectus abdominis muscle, and adjoining vasculature ...
The transversospinalis group is the deep layer of the intrinsic back muscles. These muscles lie between the transverse and spinous processes and are grouped by length of the fascicles, as well as region covered. The groups are rotatores, multifidus, and semispinalis.
The transversus abdominis muscle, named according to the direction of its muscle fibres, is one of the flat muscles that form the anterior abdominal wall. It is deep to the internal oblique muscle and ends in the anterior aponeurosis, which ultimately blends with the linea alba.
The trapezium (greater multangular) is one of the eight carpal bones of the hand. It is the most lateral (radial) bone of the distal row, located between the scaphoid and the first metacarpal bone . It articulates with the scaphoid proximally, the trapezoid medially, and the thumb and index meta...
Trapezium fractures are uncommon carpal bone injuries. They can either occur in isolation or combination with another carpal bony injury.
Isolated fractures of the trapezium are only thought to account for 3-5% of all carpal fractures 1-2.
They can be broadly classifie...
The trapezium secondarium (or trapezium secundarium or secondary trapezium) is an accessory ossicle of the wrist. It can be seen adjacent to the tubercle of the trapezium superomedially 1,2.
According to Pfitzner, the trapezium secondarium is one of four potential secondary ossifica...
The trapezius muscle is a large, broad superficial muscle of the posterior neck and back. It gains its name from its diamond shape. Along with sternocleidomastoid muscle, it is invested by the superficial layer of the deep cervical fascia, which splits around it.
origin: superior nuch...
The trapezoid bone (also known as the os trapezoideum or the lesser multangular) is the smallest carpal bone in the distal row, sitting lateral to the capitate.
The trapezoid is an irregular, boot-shaped bone. The dorsal surface is larger than the palmar surface and i...
The trapezoid ligament is one of two components forming the coracoclavicular (CC) ligament. The conoid ligament is the other component.
The trapezoid ligament is a broad quadrilateral ligament that is quite thin. Its positioned almost horizontally. It is the anterolateral part of...
This is a basic article for medical students and other non-radiologists
Trauma films are ubiquitous in an orthopaedic attachment and also in the Emergency Department.
In most cases, a trauma film will come with two views. It is important that you review both films because in some cases a fract...
Traumatic neuromas may occur from acute or chronic injury to a nerve.
The patient presents with a focal area of pain and tenderness to palpation. There should be a history of injury to the area. Surgery is a common source of traumatic neuromas (e.g. ilioinguinal pain post...
The Trethowan sign is used to diagnose slipped capital femoral epiphysis (also called slipped upper femoral epiphysis). In this sign, the line of Klein passes above the femoral head.
It is best done on both AP and true lateralcit projections. On the AP view of a normal hip, the Klein line inter...