Radiologyguide2020

Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

2020/21

Radiology/Investigation Version

Authors: Dr. A Francella, Dr. N Dilworth

Contributors: Dr. K Asem, Dr. A Cantarutti, Dr. H Chen, Dr I Cheng, Dr. W Clayden, Dr. R Eardley, Dr. L Hillier, Dr. S Kraft , Dr. D Lawrence, Dr. M Leung, Dr K Lundine, Dr. D Nguyen, Mr. T O’Neill, Dr. T Rindlisbacher

1 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Table of Contents

Face/Head Pages 2-5

Cervical Spine Pages 6-8

Shoulder Pages 9-11 Elbow Pages 12-15

Wrist Pages 16-17 Hand Pages 18-19 Thoracolumbar Pages 20-21 Hip Pages 22-24

Knee Pages 25-28 Ankle Pages 28-32

Foot Pages 33-35 Other Pages 36-39

Dermatology Pages 40-41

2 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Face/Head Injuries

Maxillary Fracture: Fractures Le Fort Type I Le Fort Type II Le Fort Type III Tooth fracture Tooth avulsion Pulpal necrosis

Image retrieved from: https://courses.lumenlearning.com/boundless-biology/chapter/types-of-skeletal-systems/

Conjunctivitis Concussion Globe rupture Scalp Hematoma Retinal detachment Corneal Abrasion Hyphema Auricular Hematoma Otitis Media Otitis Externa Tongue laceration Oral laceration Lip laceration Herpes gladiatorum

Image retrieved from: http://heritance.me/surface-anatomy-of-skin/surface-anatomy-of-skin-neck-plastic-surgery-key

3 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Fractures seen Orbital fracture CT scan Maxillary fracture: CT scan Le Fort Type I Facial xrays Le Fort Type II Le Fort Type III Nasal Fracture Nasal xray

Mandibular Fracture Mandibular xrays, CT scan

Zygomatic Arch Fracture CT scan

Head Auricular hematoma CT head rules

Scalp hematoma CT head rules

Concussion * http://sportmedschool.com/concussion/ Imaging indications Otitis Externa If malignant – may require CT Head, MRI Otitis Media

Herpes Gladiatorum

Tympanic Membrane Rupture Dental Tooth fracture Xray – Dental – DENTIST

Tooth avulsion/luxation Xray – facial, dental - DENTIST

Tongue laceration

Oral laceration

Pulpal necrosis

Lip laceration Consider plastics referral/ER

4 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Ocular Conjunctivitis

Globe rupture CT scan – r/o assoc. orbital fracture

Blunt Globe trauma CT scan – r/o assoc. orbital fracture

Glaucoma Tonometer

Retinal detachment Fundoscopy, US with tegaderm

Corneal abrasion Slit lamp

Hyphema Slit lamp, tonometer, +- CT scan r/o assoc. orbital fracture Corneal Laceration

Traumatic Iritis Tonometer, CT scan – r/o assoc. orbital fracture Traumatic Retinitis Tonometer, CT scan – r/o assoc. orbital fracture

Intracranial/Spinal Column Chiari Malformation MRI Head and Neck(preferred), CT Head Subdural hematoma CT head

Subarachnoid hematoma CT head, +- lumbar puncture

Epidural hematoma CT head

Syringomyelia MRI Cspine

Intracranial Hypertension MRI head, Lumbar puncture pressures – NEUROLOGY referral Vertebral Arterial CTA Head/neck, MRA Dissection Meningitis Lumbar puncture +- CT head

5 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Cervical Spine Injuries

Odontoid Fracture Jefferson Fracture

Hangman’s Fracture

Burst Fracture Pedicolaminar Wedge Fracture fracture-separation

Laminar Fracture Pillar Fracture

Teardrop Fracture Bilateral facet fracture/dislocation

Image retrieved from: https://www.shutterstock.com/es/image-illustration/cervical-spine-structure-vertebral-bones-anatomy-415445710 Clay Shoveler Hyperflexion sprain Fracture Transverse Myelopathy (ligaments not shown) Central Cord Syndrome Anterior Spinal Cord Syndrome Brown-Sequard Syndrome Posterior Spinal Cord Syndrome Transient Quadriparesis SCIWORA Cervical Stingers Myelomalacia Cervical radiculopathies Cervical neuropathies

Occipital Neuralgia

Trapezius Strain Wry Neck Whiplash-associated Injuries

Degenerative Disc Disease Thoracic Outlet Syndrome Osteoarthritis Image retrieved from: http://libcat.org/gross-anatomy-of-the-skeletal-muscles-muscles-of-the-head

6 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Image retrieved from: https://humananatomyly.com/cross-section-of-the-spine/cross- section -of-the-spine-cross-section-of-human-vertebrae-spine-cross-section-anatomy- spine/

7 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Fractures seen C1 – Jefferson Immobilize Cspine – ER – CT Cspine C2: Immobilize Cspine – ER – CT Cspine Hangman’s Ondontoid C3-C7 Immobilize Cspine – ER – CT Cspine Burst Wedge C6-T1 Immobilize Cspine – ER – CT Cspine Clay Shoveler Pillar fracture Immobilize Cspine – ER – CT Cspine

Pedicolaminar fracture- Immobilize Cspine – ER – CT Cspine separation Teardrop fracture Immobilize Cspine – ER – CT Cspine

Laminar fracture Immobilize Cspine – ER – CT Cspine

Bilateral facet Immobilize Cspine – ER – CT Cspine fracture/dislocation Spinal Cord Transverse Myelopathy MRI cspine

Central Cord Syndrome MRI cspine

Anterior Spinal Cord MRI cspine Syndrome Brown-Sequard Syndrome MRI cspine

Posterior Spinal Cord MRI cspine Syndrome Transient Quadriparesis MRI cspine

C-Spine Cervical Stingers Xray Cspine, CT Cspine, MRI Cspine, MRI neurography – Brachial plexus Spinal cord injury without MRI Cspine/Tspine/Lspine as radiographic abnormalities indicated (SCIWORA)

8 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Whiplash-associated CT Cspine, MRI Cspine disorder Myelomalacia MRI Cspine

Cervical radiculopathies MRI Cspine

Cervical neuropathies MRI Cspine

Thoracic Outlet Syndrome Vascular Lab studies, MRI brachial plexus Wry Neck US neck – if lymphadenopathy

Degenerative Disc Xray Cspine, CT Cspine, MRI Cspine Disease/Osteoarthritis Hyperflexion sprain Xray Cspine, CT Cspine, MRI Cpsine

Musculotendinous/Other Occipital Neuralgia Clinical, Local diagnostic nerve block

Trapezius strain

9 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Shoulder Injuries

Acromioclaviuclar injuries Osteolysis of the distal clavicle Clavicle fractures

Acromial fractures

Bankart Lesions Hill -Sachs Lesion Anterior Dislocation Posterior Dislocation Osteoarthritis Multidirectional Instability Adhesive Capsulitis Referred Pain

Image retrieved from: https://brentbrookbush.com/articles/anatomy-articles/joint-anatomy/shoulder-glenohumeral-joint/

Biceps tenosynovitis Biceps rupture/tear

Pectoralis tear

Image retrieved from: http://anatomysciences.com/hip-muscles-and-tendons/hip-muscles-and-tendons-chart-of-human-shoulder-muscles-chest-muscles-anatomy-anatomy/ Sternoclavicular injuries

Subacromial impingement Calcific tendinitis Subacromial bursitis

Image retrieved from: https://humananatomycharty.com/anatomy-of- the-shoulder-muscles/anatomy-of-the-shoulder-muscles-anatomy-of- Scapular fractures the-shoulder-muscles-muscles-of-the-upper-arm-and/ Image retrieved from: https://www.illustrationsource.com/stock/image/506596/a- posterior-view-of-the-muscles-of-the-human-upper- arm/?&results_per_page=1&detail=TRUE&page=2 10

Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport INVESTIGATION Tendon/Muscle seen Type Supraspinatus US shoulder, MRI shoulder Infraspinatus US shoulder, MRI shoulder Teres Minor US shoulder, MRI shoulder

Subscapularis US shoulder, MRI shoulder

Deltoid US shoulder, MRI shoulder

Biceps tenosynovitis US shoulder, MRI shoulder

Biceps rupture/tear US shoulder, MRI shoulder

Pectoralis tear US shoulder, MRI MSK Chest

Bone/Ligaments Acromioclavicular injuries Xray AC, CT shoulder, MRI Shoulder Clavicle fractures Xray clavicle, CT clavicle

Scapular fractures Xray scapular views, CT scapula

Acromial fractures Xray shoulder, CT shoulder, MRI shoulder Bankart lesions Xray Shoulder, MRI shoulder, CT shoulder, MRA shoulder Hill-Sachs lesions Xray Shoulder, MRI shoulder, CT shoulder, MRA shoulder Anterior dislocation Xray Shoulder, MRI shoulder, CT shoulder, MRA shoulder Posterior dislocation Xray Shoulder, MRI shoulder, CT shoulder, MRA shoulder Sternoclavicular injuries CT chest (if concern for post.) MRI MSK Chest Osteoarthritis Xray shoulder

Other Multidirectional instability Xray shoulder, MRI shoulder

Calcific Tendinitis Xray shoulder, US shoulder

11 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Adhesive Capsulitis R/O other causes: Xray shoulder, MRI shoulder, US shoulder (may see thickening of coracohumeral ligament) Osteolysis of distal Xray AC, CT shoulder clavicle Subacromial Impingement US shoulder

Subacromial bursitis US shoulder

Suprascapular nerve MRI Shoulder impingement SLAP and Labraltears MRI shoulder, MRA shoulder

Referred Pain

12 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Elbow Injuries

Muscles and Tendons

Distal Biceps Tendinitis Distal Biceps Tear Medial Epicondylitis

Triceps Tear Lateral Snapping Triceps Epicondylitis Syndrome

13 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury # of cases seen Age/Gender Sport Type INVESTIGATION Lateral Epicondylitis US elbow, Xray elbow

Medial Epicondylitis US elbow, Xray elbow

Distal Biceps Tendinitis US elbow, Xray elbow

Distal Biceps Tear US elbow, Xray elbow

Triceps Tear US elbow, Xray elbow

Snapping Triceps Syndrome Dynamic US elbow

Other

Loose bodies Xray elbow, MRI elbow

14 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Bones, Ligaments, and Other Injuries

Medial Epicondyle Apophysitis/Little League Elbow Ulnar nerve subluxation Ulnar nerve injury Osteochondritis Dissecans Elbow osteoarthritis Fractures Panner’s Disease Elbow Dislocation Olecranon bursitis Stress Fracture Posterior Impingement/ Valgus overload

Ulnar Collateral Ligament Injuries Medial Epicondylitis Apophysitis/Little League Elbow

Radial Tunnel Syndrome

15 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Bone/Ligament # of cases seen Age/Gender Sport INVESTIGATION Type Osteochondritis Dissecans Xray elbow, MRI elbow, MRA elbow, CT elbow Medial Epicondyle Xray elbow, MRI elbow Apophysitis/Little League Elbow Ulnar Collateral Ligament Xray elbow (valgus stress), Injuries MRI elbow, MRA elbow

Elbow Dislocations Xray elbow, MRI elbow

Posterior Impingement/ Xray Elbow Valgus overload

Elbow osteoarthritis Xray Elbow

Ulnar nerve subluxation Dynamic US elbow

Ulnar nerve injury EMG, NCS, MRI neurography

Radial Tunnel R/O other (US elbow, MRI Syndrome/Posterior elbow, NCS, EMG – all may be Interosseous Nerve normal) Entrapment Olecranon Bursitis US elbow, consider aspiration C+S, crystallography Stress fractures Xray elbow, MRI elbow, CT elbow Panner’s Disease Xray elbow, MRI elbow

Fractures Xray elbow

Synovial Plica MRI elbow

Radial collateral ligament MRI elbow, MRA elbow injury OTHER

16 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Wrist Injuries

Scaphoid fracture

Hook of Hamate fracture

DRUJ injury TFCC injury Kienböck’s disease Impingement syndromes Scapholunate dissociation Lunaotriquetrial injury Lunate/perilunate dislocation Image retrieved from:Distal http://www.days Radius fracture-eye.com/hip -anatomy-muscles/adorable-branch-hip- anatomy-biology-concerned-study-shocking-discipline-nice-ideas-handmade-wonderful/ Distal radial physeal stress injury Image retrieved from: http://www.thepinsta.com/skeleton-hand-dorsal- view_0IO1R1d4bmD57X2DD8cvLFpx84TSQi7mL%7C5HL3SqYs8/

Ganglion cyst

De Quervain’s tenosynovitis

Intersection syndrome

Ulnar nerve compression

Image retrieved from: Image retrieved from: Carpal Tunnel syndrome https://sites.google.com/site/3r03msklearningportfolio/?tmpl=%2Fsystem https://www.pinterest.ca/pin/204069426844687303/?lp=true %2Fapp%2Ftemplates%2Fprint%2F&showPrintDialog=1

17 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Bone seen Distal radius fracture Xray Wrist Scaphoid fracture Xray Wrist, scaphoid views Hook of Hammate fracture Xray wrist, hamate views

Kienböck’s disease Xray wrist

Distal radial physeal stress injury Xray Wrist, MRI wrist

Impingement syndromes

Ligament/Cartilage Scapholunate injury Xray wrist, scaphoid views (including closed fist) Lunotriquetral injury Xray wrist

Lunate/perilunate dislocation Xray wrist

Distral Radioulnar joint (DRUJ) Xray Wrist, MRI wrist instability Triangular Fibrocartilage US wrist, xray wrist, complex (TFCC) injury MRI wrist Tendon DeQuervain’s tenosynovitis US wrist

Intersection syndrome US wrist

Extensor/Flexor Carpis Ulnaris US wrist, Dynamic US tendinopathy/Snapping wrist Flexor Carpi radialis US wrist tendinopathy Nerve Carpal tunnel syndrome EMG, NCS

Ulnar nerve compression EMG, NCS

Other Ganglion Cyst US wrist Dislocation of CMC Xray wrist

18 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Hand Injuries

Tuft fracture PIPJ dislocations Volar Plate injuries Rheumatoid Arthritis Psoriatic Arthritis Reactive Arthritis

MCPJ dislocations

Boxer’s fracture

CMCJ Osteoarthritis

Bennett fracture

Image retrieved from: http://www.days-eye.com/hip-anatomy-muscles/adorable-branch-hip- anatomy-biology-concerned-study-shocking-discipline-nice-ideas-handmade-wonderful/

Image retrieved from: http://www.thepinsta.com/skeleton-hand-dorsal- view_0IO1R1d4bmD57X2DD8cvLFpx84TSQi7mL%7C5HL3SqYs8/

Subungal hematoma Mallet finger

Jersey finger

Trigger finger Pulley Injuries UCL injury Dupuytren’s Stener lesion contracture

Carpal Tunnel Syndrome

Guyon’s Canal Image retrieved from: https://humananatomycharty.com/hand-muscle- Syndrome Image retrieved from: anatomy/hand-muscle-anatomy-right-hand-muscles-anatomy-human- https://www.pinterest.ca/pin/204069426844687303/?lp=true anatomy-labelled/

19 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Tendon/Muscle/Ligament seen Jersey Finger Xray finger Mallet Finger Xray finger Trigger Finger US finger Pulley Injuries US finger Ulnar Collateral Ligament US D1/Thumb injuries Stener Lesion US D1, xray D1 Bone/Joint Bennett Fracture Xray hand Boxer’s Fracture Xray Hand Tuft Fracture Xray finger Volar Plate injuries Xray finger PIPJ dislocations Xray finger MCPJ dislocations Xray hand CMCJ Osteoarthritis Xray hand Other Duputyren’s contracture US hand

Carpal Tunnel Syndrome NCS/EMG

Guyon’s Canal Syndrome NCS/EMG

Rheumatoid Arthritis Xray/US wrist/hand, arthrocentesis, Inflammatory bloodwork Psoriatic Arthritis Xray/US wrist/hand, arthrocentesis, Inflammatory bloodwork Reactive Arthritis Xray/US wrist/hand, arthrocentesis, Inflammatory bloodwork Subungal Hematoma Xray finger

Acute Compartment Syndrome Compartment testing

Chronic Regional Pain Syndrome Xray wrist/hand

Referred Pain

20 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Thoracolumbar Spine Injuries

Scoliosis Adult Degenerative Spinal Deformity

Transverse Process Fractures Spondylolitis Spondylolithesis Scheuermann’s Kyphosis Discitis Lumbar Spinal Stenosis Mechanical Low Back Pain Lumbar Disc Herniation/Radiculopathy Cauda Equina Syndrome Inflammatory Spondyloarthropathy Osteoporotic Compression Fractures Metastatic Spine Disease

Bertolotti’s Syndrome Sacroiliac Dysfunction

Image retrieved from: http://anatomysciences.com/spine-diagram-with-labels/spine-diagram- with-labels-human-anatomy-diagram-spine-bones-diagram-human-spine-diagram/

21 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Child/Adolescent seen Scoliosis Xray scoliosis survey Spondylolitis Xray Lspine, MRI Lspine Spondylolisthesis Xray Lspine, MRI Lspine, CT Lspine Scheuermann’s Kyphosis Xray Tspine, MRI Tspine

Discitis MRI spine (area of concern), Blood cultures, and Infectious workup Adult Mechanical Low Back Pain Atraumatic, < 3 months, - Pattern 1a Flexion type no red flag/neurological - Pattern 1b Flexion type sx - no imaging required - Pattern 2 Extension - Pattern 3 Leg-dominant constant - Pattern 4 Leg dominant intermittent Lumbar Disc MRI Lumbar spine Herniation/Radiculopathy Cauda Equina Syndrome MRI Spine

Inflammatory MRI Spine and sacroiliac Spondyloarthropathy joints Older Adult Lumbar Spinal Stenosis MRI lumbar spine

Osteoporotic Compression Xray Tspine/Lspine Fractures Metastatic Spine disease Xray Thoracolumbar spine, Bone scan, MRI spine Adult Degenerative Spinal Xray Spine, MRI spine Deformity Other Sacroiliac Dysfunction

Transverse Process fracture Xray Lspine, MRI Lspine

Schmorl’s nodes MRI Lspine

22 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Bertolotti’s Syndrome Xray Lspine, MRI Lspine, CT Lspine

Hip Injuries

Sacroiliac impingement Refered back pain

Hip Osteoarthritis Femoroacetabular impingement Avascular necrosis Femoral neck stress fracture Labral tear Slipped capital femoral epiphysis Legg-Calvé -Perthes

Pelvic avulsion fractures Greater tuberosity pain syndrome

Osteitis Pubis

Image retrieved from: http://www.days-eye.com/hip-anatomy-muscles/adorable-branch-hip- anatomy-biology-concerned-study-shocking-discipline-nice-ideas-handmade-wonderful/

Hip flexor/adductor Hip Osteoarthritis tendinopathy Gluteal tendinopathy Piriformis syndrome Ischiofemoral impingement

Hamstring tendinopathy

Inguinal-related groin pain (Sport Hernia/Athletic pubalgia)

LFCN entrapment Lumbar radiculopathy

23 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Image retrieved from: https://humananatomyly.com/leg-knee-muscles-diagram/leg-knee- muscles-diagram-25-best-ideas-about-knee-joint-anatomy-on-pinterest-anatomy-of/

24 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of Age/Gender Sport Type INVESTIGATION Anterior Pain cases seen Hip osteoarthritis Xray Pelvis and Hip (AP pelvis, affected hip) Femoroacetabular Xray Pelvis and Hips (incl.Dunn’s Impingement syndrome views) Avascular necrosis Xray Pelvis and Hip

Femoral neck stress fracture Xray Femur, CT femur, MRI femur

Labral tear MRI/MRA hip

Osteitis pubis MRI groin pain protocol

Hip flexor/adductor US hip tendinopathy Inguinal related groin pain MRI groin pain protol, US abdo (R/O (Sport hernia/Athletic hernia), Diagnostic nerve blocks pubalgia)*abdo wall nerve impingements Lateral Pain Greater Trochanter Pain US greater trochanter, MRI hip Syndrome (IT band, glutes, bursa, etc) Lateral Femoral Cutaneous Diagnostic LFCN injection Nerve (LFCN) entrapment Lumbar radiculopathy MRI Lspine

Posterior Pain Gluteal tendinopathy US gluts/hip

Referred back pain: referral MRI Lspine L5, SI joint Hamstring tendinopathy US hamstring

Hip osteoarthritis Xray Pelvis and hip

Piriformis syndrome MRI hip

Sacroiliac impingement

25 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Ischiofemoral impingement MRI hip

Pediatric Slipped capital femoral Xray Pelvis, hip (include frog leg epiphysis (SCFE) views) Legg-Calvé-Perthes Xray Pelvis and hip

Pelvic avulsion fractures

- ASIS Xray Pelvis

- AIIS Xray Pelvis

- Iliac crest Xray Pelvis

- Ischeal Ramus Xray Pelvis

- Pubic tubercle Xray Pelvis

- Lesser trochanter Xray Pelvis/hip

26 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Knee Injuries Pigmented villonodular synovitis Osteoarthritis Septic Arthritis Chondrocalcinosis LOCKED knee Meniscal tears Referred pain Discoid Meniscus Osteochondroma SONK Posterolateral corner injury Bone tumour

Osteochondral defect Osteochondritis dissecans

Segond fracture

Tibial Spine Avulsion Fracture Tibial Plateau Fracture Superior TIb/Fib Dysfunction

Patellar fracture Osgood-Schlatter Disease Tibial tubercle avulsion

Sinding-Larsen-Johansson Syndrome Image retrieved from: http://www.days-eye.com/hip-anatomy-muscles/adorable-branch-hip- anatomy-biology-concerned-study-shocking-discipline-nice-ideas-handmade-wonderful/

Medial Patellofemoral Ligament Patellar tendinitis Quadriceps tendinitis ITBFS Calcific tendinitis Hamstring tendinitis Prepatella bursitis Baker’s Cyst PFPS

Pes anserine bursitis

Image retrieved from: https://humananatomyly.com/leg-knee-muscles-diagram/leg-knee- muscles-diagram-25-best-ideas-about-knee-joint-anatomy-on-pinterest-anatomy-of/

27 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport INVESTIGATION Bone/Joint seen Type Osteochondral defect Xray knees (B/L) (AP, Lat, Skyline, tunnel, WB), MRI knee, MRA knee Osteochondritis dissecans Xray knees (B/L) (AP, Lat, Skyline, tunnel, WB), MRI knee, MRA knee Pigmented villonodular MRI knee synovitis Meniscal tears MRI knee

Discoid Meniscus MRI knee

Segond fracture Xray Knee +- MRI knee

Tibial spine avulsion fracture Xray knee +- MRI knee

Tibial plateau fracture Xray knee, CT knee, MRI knee

Patellar fracture Xray knee, CT knee

PFPS – alignment, overuse, Xray knee, MRI knee instability, trauma, chondral defect Osteoarthritis – Xray knees (AP, Lat, Skyline, tunnel, unicomparmental, WB) bicompartmental, tricompartmental Superior Tib/Fib Dysfunction

Ligament Anterior Cruciate Ligament MRI knee

Posterior Cruciate Ligament MRI knee

Medial Collateral Ligament US knee, MRI knee

Lateral Collateral Ligament US knee, MRI knee

Medial Patellofemoral MRI knee Ligament (MPFL) Anterolateral Ligament (ALL) MRI knee

28 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Posterolateral corner injury MRI knee

Musculotendinous Patellar tendinitis US knee

Quadriceps tendinitis US knee

ITBFS MRI knee

Hamstring tendinitis US knee

Pes anserine bursitis US knee

Calcific tendinitis – US knee, xray Knee Quad/Patella Popliteus Strain MRI knee

Pediatric/Other Osgood-Schlatter Disease Xray knee

Tibial tubercle avulsion Xray knee

Spontaneous Osteonecrosis of Xray knees, MRI knees, CT knee the knee (SONK)/Insufficiency fracture) Osteochondroma Xray knee

Bone tumours Xray knee, MRI knee, CT knee, bone scan Bursitis – suprapatellar, US knee prepatellar, infrapatellar (ant/post.) Septic Arthritis Arthrocentesis, Xray knee

Chondrocalcinosis Xray knee +- arthrocentesis

LOCKED knee – ACL, loose Xray knee, MRI knee body, bucket handle meniscal tear, node synovitis, chondroma, ganglion cyst Referred pain – radiculopathy, hip, OA, SCFE/SUFE Baker’s Cyst

29 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Hoffa fat pad impingement MRI knee if chronic

Snapping Conditions – Semitendinosis, Biceps Femoris, ITB Hoffa fat pad chondroma MRI knee, xray knee

Synovitis nodes Xray knee, MRI knee

Ankle Injuries

Achilles tendon sprain/tear

Peroneal tendinopathy Peroneal subluxation Extensor Hallucis Longus Tenosynovitis

Weber Fracture Stress fracture

Calcaneal bursitis

Calcaneal fracture

Base of 5th metatarsal fracture/stress fracture/Jones fracture/Pseudo-Jones

Medial Tibial Stress syndrome/ reaction/fracture

Posterior tibial tendon dysfunction Tibialis Anterior Tenosynovitis Tibialis Posterior

tendinopathy Synovitis FHL tendinitis Posterior tibial artery pseudoaneurysm Referred30 Pain

Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Image retrieved from: https://humananatomycharty.com/anatomy-of-the-foot-ligaments- and-tendons/anatomy-of-the-foot-ligaments-and-tendons-foot-anatomy-tendons-ankle- anatomy-ligaments-and-tendons-ankle/

Syndesmotic sprain/tear

AITFL Sprain/Tear Anterior Impingement Anterolateral Impingement

PITFL Sprain/Tear Posterior Impingement

PTFL Sprain/Tear

Os trigonum syndrome Referred pain

CFL Sprain/Tear Sinus Tarsi Coarctation of talocalcaneal

ATFL Sprain/Tear Chronic Lateral Ankle Instability Gout Cuboid avulsion fracture Pseudogout Cuboid syndrome

Talar dome fracture Osteochondritis dissecans Pilon/Plafond fracture Osteochondral defect

Deltoid Sprain/Tear

31 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport INVESTIGATION Anterior seen Type Anterior talofibular ligament US ankle (ATFL) sprain or tear Tibialis anterior tenosynovitis US ankle (skate bite) Extensor Hallucis US ankle/foot tenosynovitis (skate bite) Anterior inferior tibiofibular Xray ankle with stress views, MRI ligament (AITFL) sprain or ankle tear Anterior impingement Xray ankle

Talar dome fracture Xray ankle, CT ankle, MRI ankle

Osteochondral defect/ Xray ankle, CT ankle, MRI ankle Osteochondritis dissecans Lateral ATFL sprain or tear US ankle Chronic lateral ankle instability MRI ankle Anterolateral impingement Xray ankle syndrome Posterior impingement Xray ankle syndrome Weber fractures Xray ankle Fibular stress fracture Xray tibia/fibula, MRI tibia/fibula, CT tibia/fibula Talar dome fracture Xray ankle, CT ankle, MRI ankle

Osteochondral defect/ Xray ankle, CT ankle, MRI ankle Osteochondritis dissecans Peroneal tendinopathy US ankle

Peroneal subluxation Dynamic US ankle

Calcaneofibular ligament Ankle US (CFL) sprain/tear Sinus tarsi Cuboid syndrome

32 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Cuboid avulsion fracture Xray foot

Base of the 5th metatarsal Xray foot fractures (acute fracture/Stress fracture/Jones fracture/pseudo- Jones fracture) Referred pain from lumbar spine, peroneal nerve, or STFJ Medial Deltoid sprain/tear US ankle

Tibialis Posterior tendinopathy US ankle

Posterior tibial tendon US ankle dysfunction Spring ligament sprain/tear MRI foot

Synovitis, joint effusion

Medial tibial traction Exertional compartment testing, Bone syndrome/stress scan, MRI tibia/fibula reaction/fracture Navicular fracture Xray foot, MRI foot

Mueller Weiss Syndrome Xray foot, CT foot, MRI foot

Os Naviculare synchondrosis Xray foot (incl. bilateral AP WB views of feet) Flexor Hallucis longus US foot tendinopathy Posterior tibial artery US ankle, CTA pseudoaneurysm Referred pain from lumbar spine Posterior Achilles tendinopathy/tear US ankle

Os trigonum syndrome Xray ankle

Posterior inferior tibiofibular Xray ankle (incl. stress views) MRI ligament (PITFL) sprain or tear ankle Posterior talofibular ligament (PTFL) sprain or tear Pilon/Plafond fracture Xray ankle, CT ankle

33 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Posterior impingement Xray ankle

Calcaneal bursitis US heel/achilles Calcaneal fracture Xray calcaneus, CT calcaneus

Other Syndesmotic sprain/tear Xray ankle (incl. stress views)

Coarctation of talocalcaneal Xray ankle, CT ankle, MRI ankle

Coarctation of Xray ankle, CT ankle, MRI ankle calcaneonavicular Gout Xray area, arthrocentesis for crystallography Pseudogout Xray area, arthrocentesis for crystallography Complex regional pain Xray area syndrome

34 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Foot Injuries

Freiberg’s osteochondritis Hallux injury valux/limitus Seasmoid Bone (plantar) 1st MTP joint *fracture Talus fracture sprain *stress fracture Talus stress fracture MTP plantar plate *sesamoiditis sprain/tear *lateral subluxation MTP synovitis *bipartiate sesamoid sprain Spring ligament tear

Lisfranc injury

Talonavicular dislocation Midtarsal joint sprain Fracture/Stress fracture of navicular,

cuboid, cuneiforms Os naviculare Subtalar Cuboid Syndrome dislocation Tarsal coalition Kohler’s disease Metatarsal-cuneiform synovitis

Fracture Stress Fracture Image retrieved from: https://digikalla.info/foot-anatomy-bones/foot-anatomy- bones-foot-bone-metatarsal-bone-tarsal-bone-anatomy-in-detail-bone-free/ Os vesalianum Iselin’s disease

Hammer/claw toe

Peroneal tendinopathy

Extensor tendinopathy

Medial calcaneal entrapment Tarsal tunnel syndrome Morton’s neuroma Joplin’s neuritis

Flexor digitorum/hallux tenosynovitis Lateral plantar entrapment Flexor tendon tear

Abductor hallucis strain Pes planus Pes cavus Plantar fascia strain

Tibialis posterior tendinopathy

Plantar fascia – fasciitis, rupture Fat pad – contusion, atrophy Image retrieved from: http://madeinkibera.com/anatomy-top-of-foot

Image retrieved from: http://madeinkibera.com/anatomy-top-of-foot#

35 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã

Injury: # of cases Age/Gender Sport Type INVESTIGATION Hindfoot seen Bone Xray calcaneus, CT - Facture: talus, calcaneus calcaneus, Xray ankle, - Stress #: talus, calcaneus CT ankle Joint Subtalar – Xray ankle, - Subtalar dislocation CT ankle - Midtarsal joint sprain Spring ligament -MRI - Spring ligament tear foot - Talonavicular dislocation Talonavicular dislocation – Xray foot, CT foot Other Fasciitis – US foot - Plantar fascia – fasciitis, rupture Fibroma – US foot, MRI - Plantar fibroma foot - Fat pad – contusion, atrophy Nerve - medial calcaneal entrapment - lateral plantar entrapment - tarsal tunnel syndrome Midfoot Bone Xray foot, CT foot - Fracture – cuboid, navicular - Stress # - navicular, cuboid, cuneiform - Os naviculare - Cuboid syndrome - Tarsal coalition - Kohler’s disease Joint Xray foot, CT foot, MRI - Lisfranc injury (sprain, fracture, foot dislocation) Tendon US foot - Extensor tendinopathy (ie. Tibialis anterior) - Tibialis posterior tendinopathy - Peroneal tendinopathy - Abductor hallucis strain Other - Pes planus - Pes cavus - Plantar fascia strain Forefoot

36 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã Bone Sesamoid injuries - Xray - Fracture – sesamoid, 5th MT foot -sesamoid views, (styloid, metaphyseal-diaphyseal, MRI foot shaft), 1st-4th MTs - Stress # - seasomid, MT shaft - 5th MT – os vesalinum, Iselin’s disease - Sesamoid – sesamoiditis, lateral subluxation, bipartiate sesamoid sprain - Freiberg’s osteochondritis Joint Xray Foot D1- MRI foot - Hallux valgus/limitus D1 - MTP/metatarsal-cuneiform synovitis (metatarsalgia) - 1st MTP joint sprain (turf toe) - MTP plantar plate sprain/tear (floating toe syndrome) Tendon Xray Foot D1- MRI foot - Flexor digitorum/hallux D1 tenosynovitis - Flexor tendon tear (a/w turf toe) Nerve Morton’s Neuroma - US - Morton’s neuroma foot - Joplin’s neuritis Skin Corns Calluses Plantar wart Subungal hematoma Onychomycosis Onychocryptosis Piezogenic Papules Other Referred pain Peripheral neuropathy Radiculopathy Complex regional pain syndrome

37 Sports & Exercise Medicine Differential Guidebookã Dr. A Francella, Dr N Dilworth 2020/21ã