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●
OSTEOARTHRITIS ●
ACHILES TENDON RUPTURE
●
RHEUMATOID ARTHRITIS ●
POSTERIOR TIBIAL TENDON
RUPTURE
●
DISH
●
TENDINOSIS
●
ANKYLOSING SPONDYLOSIS
●
ROTATOR CUFF INJURIES
●
GOUT
●
GLENOHUMERAL
●
CPPD
INSTABILITY
●
AVASCULAR NECROSIS OF ●
EPICONDYLITIS
HIP
●
BICEPS TENDON RUPTURE
●
ILIOPSOAS BURSITIS
●
CARPAL TUNNEL SYNDROME
●
MENISCAL TEARS
●
AVASCULAR NECROSIS OF
●
ACL INJURY
SCAPHOID
OSTEOARTHRITIS
●
RADIOLOGICAL FEATURES
● PRIMARY – IDIOPATHIC
● SECONDARY – MULTIPLE CAUSES
● JOINT SPACE NARROWING
● EROSIVE OR HYPERTROPHIC
● SUBCHONDRAL SCLEROSIS
VARIETY ● SUBCHONDRAL EROSION
● AFFECTS WEIGHT BEARING ● SUBCHONDRAL CYSTS AND
JOINTS
MICROFRACTURES
● CAUSES KNEE PAIN AND
RESTRICTON OF MOVEMENT AND
● OSTEOPHYTE FORMATION
JOINT DESTRUCTION, DISABILITY ● SUBLUXATION OF JOINTS
● CALCIFICATION OF
FIBROCARTILAGE AND
HYALINE CARTILAGE
XRAY KNEE OA
● JOINT SPACE
NARROWING
● SUB CHONDRAL
SCLEROSIS
RHEUMATOID ARTHRITIS ●
RADIOLOGICAL FEATURES
● INFLAMMATORY ARTHRITIS ● INITIALLY JOINT WIDENING
● . PANNUS FORMATION WITH BECAUSE OF SYNOVITIS ,
DESTRUCTION OF UNDERLYING EFFUSION AND THEN EROSION
CARTILAGE AND JOINT NARROWING
● AFFECTS SMALL JOINTS OF ● SOFT TISSUE SWELLING
HANDS AND FEET MORE THAN ● SUB CHONDRAL CYSTS PRESENT
WEIGHT BEARING JOINTS
● NO SUBCHONDRAL SCLEROSIS
● MARGINAL EROSIONS – DIFF
FROM OSTEOARTHRITIS WHICH ● OSTEOPOROSIS – PERIARTICULAR
HAS CENTRAL EROSIONS TO START WITH THEN DIFFUSE
AND THEN REGIONAL PRESENT
● SPINE – ONLY CERVICAL AND
RARELY LUMBAR SPINE ● JOINT SUBLUXATION AND
INVOLVEMENT SEEN DISLOCATION.
● PIP JT > DIP JT DIFFERENTIATES ● ARTHRITIS MUTILANS – FINAL
IT FROM BOTH OA AND STAGE OF JOINT DESTRUCTION
PSORIATIC OA
● CAN CAUSE SECONDARY OA
1.XRAY-RA
● RA –
● JOINT SPACE
NARROWING
● JOINT
DESTRUCTION
● OSTEOPOROSIS
● NO SCLEROSIS
2.XRAY - RA
● JOINT
NARROWING
● JOINT
DESTRUCTION
● SOFT TISSUE
SWELLING
DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
●
SPINE – R> L
●
COMMONLY AFFECTS
ELDERLY PATIENTS ●
ANTERIOR LONGITUDINAL
LIGAMENT OSSIFICATION
●
FLOW ING OSSIFICATION OF
●
SPURS DEVELOP FROM THE
LIGAMENTS OF THE SPINE IN
OSSIFIED LIGAMENTS WHICH
A SEGMENT INVOLVING 4 OR
MAY FUSE WITH THE ADJACENT
5 VERTEBRAE SPURS
CONTIGUOUSLY
● OSSIFICATION OF POSTERIOR
●
PRESERVATION OF DISC LONGITUDINAL LIGAMENT CAN
HEIGHT TO DIFFERENTIATE CAUSE SPINAL STENOSIS
FROM DEGENERATIVE ●
CAN OCCUR AS ISOLATED
PROCESS
CONDITION
●
NO JOINT FUSION AS IN AS ● RADIOGRAPHIC PICTURE
●
NOT AN ARTHRITIC ●
BRIDGING OSTEOPHYTES
CONDITION BUT A REACTION
AFFECTING MULTIPLE
TO STRESS
LEVELS OUT OF PROPOTION
●
ASYMPTOMATIC OR C/F OF TO THE DEGREE OF
BACKPAIN ,STIFFNESS , DEGENRATIVE CHANGE
TENDINOSIS
1.XRAY DISH
● BRIDGING
OSTEOPHYTES
AFFECTING
MULTIPLE LEVELS
OUT OF
PROPOTION TO
THE DEGREE OF
DEGENRATIVE
CHANGE
2.XRAY - DISH
● BRIDGING
OSTEOPHYTES
AFFECTING
MULTIPLE LEVELS
OUT OF
PROPOTION TO
THE DEGREE OF
DEGENRATIVE
CHANGE
ANKYLOSING SPONDYLITIS
● ANKYLOSIS – JOINT FUSION
● SPONDYLITIS – INFLAMMATION OF
● SPINAL INVOLVEMENT PRECEEDS SI JOINT
INVOLVING STRUCTURES IN THE SPINE. INVOLVEMENT AND CONSISTS OF EARLY
EROSION AND SCLEROSIS OF ANTERIOR
● PROGRESSIVE , CHRONIC CONDITION CORNERS OF VERTEBRAL BODIES LEADING
TO SQUARING OF VERTEBRAL
● AFFECTS YOUNG ADULTS 25-35YRS BODIES ,SYNDESMOPHYTE FORMATION,
LONGITUDINAL LIGAMENT MINERALIZATION
● AFFECTS SACROILIAC JOINTS,SPINAL AND ANKYLOIS OF APOPHYSEAL JOINTS
APOPHYSEAL JOINTS, ANNULUS FIBROSIS
AND THE DEEP LAYERS OF THE ANTERIOR ● ON MATURATION SYNDESMOPHYTES
LONGITUDINAL LIGAMENT PRODUCES BAMBOO SPINE APPEARANCE
● M:F = 10: 1 ● SI JT :EARLY UNILATERAL , THEN
CLASSICALLY B/L SYMMETRICAL
● BONY ANKYLOSIS – EARLY AND RAPID -
HALLMARK OF THE DISEASE ● INTIAL FINDING: LOSS OF JOINT MARGIN
DEFINITION
● RADIOLOGICAL FEATURES
● LATER: JOINT WIDENING ,IRREGULARITY,
● PRINCIPLE SITES OF INVOLVEMENT : EROSION ON THE ILIAC SIDE LEADING TO
LOWER 2/3 SI JOINT,HIPS, KNEES,ANKLES, SCLEROSIS AND ULTIMATELY ANKYLOSIS
SHOULDERS, COSTOVERTEBRAL JOINT,
MANUBRIOSTERNAL JOINT,SYMPHYSIS ● LIGAMENT INVOLEMENT RESULTS IN
PUBIS. INDISTINCTNESS OF CORTICES OF BOTH
BONES DUE TO 'WHISKERING OF BONE' ON
● SMALL JOINTS NOT INVOLVED EITHER SIDE LEADING TO ANKYLOSIS.
● SPINE:STARTS IN TL REGION AND
PROGRESSES UPWARDS
1.XRAY - AS
● SQUARING OF
VERTEBRAE
● SYNDESMOPHYTE
S
2.XRAY -AS
● SI JOINT SPACE
NARROWING
● SCLEROSIS
● FUSION -
ANKYLOSIS
3.XRAY - AS
● SI JOINT
SCLEROSIS
GOUT ●
RADIOLOGICAL FEATURES DEVELOP
ONLY IN CHRONIC TOPHACEOUS GOUT.
●
INBORN ERROR OF PURINE
METABOLISM WHICH CAUSES
●
EROSIONS + SOFT TISSUE SWELLINGS
HYPERURICEMIA , DEPOSITION OF ARE THE HALLMARK OF THE DISEASE.
MONOSODIUM URATE CRYSTALS IN ●
JOINT NARROWING
JOINTS AND SOFT TISSUES
RESULRING IN RECURRENT ● PERIARTICULAR , MARGINAL OR
EPISODES OF ACUTE ARTHRITIS SUBCHONDRAL EROSION WHICH ARE
CYST LIKE WITH A THIN SCLEROTIC RIM
●
AUTOSOMAL DOMINANT CONDITION
●
THESE ARE LOCATED REMOTE FROM
●
AGE – THIRD DECADE OF LIFE THE ARTICULAR SURFACE AND HELPS
● 4 STAGES IN DISEASE TO DIFFERENTIATE FROM RA WHERE
PROGRESSION.1.ASYMPTOMATIC THEY OCCUR ON BARE AREAS OF THE
HYPERURICEMIA 2.ACUTE GOUTY BONE.
ARTHRITIS 3.INTERCRITICAL GOUT ● HAND – SEVERE DEFORMITY WITH
4.CHRONIC TOPHACEOUS GOUT TELESCOPING SEEN DURING
●
ACUTE ARTHRITIS – MOST COMMON TREATMENT
EARLY MANIFESTATION ●
WRIST – MCP JT MC INVOLVED
●
TYPICALLY AFFECTING THE 1ST MTP● FOOT – MTP JT OF 1ST TOE
JT. INVOLVEMENT IS HALLMARK LOCATION
●
CHRONIC TOPHECEOUS GOUT – ●
HALLUX VALGUS IS A COMMON
SOFT TISSUE LUMPS OCCUR ACCOMPANIMENT
CONTAINING MSU DEPOSITS.
2.XRAY - GOUT
● SOFT TISSUE
SWELLING
● MTP,PIP JT
DESTRUCTION
PSEUDOGOUT(CPPD)
●
CPPD – CALCIUM PYROPHOSPHATE ●
UNIFORM CARTILAGE THINNING,
DIHYDRATE DEPOSITION DISEASE . MULTIPLE SUBCHONDRAL CYSTS AND
OSTEOPHYTES
●
DEPOSITION OF CPPD IN JOINTS,
BURSAE AND TENDON SHEATHS ●
LARGE PERI ARTICULAR CALCIFIC
DEPOSITS CAN CAUSE PRESSURE
●
IF THE CONDITION IS SYMPTOMATIC
EROSIONS-
IT IS CALLED PSEUDO GOUT.
TOPHACEOUSPSEUDOGOUT
●
ASYMPTOMATIC IN WHICH CASE THE ● GIANT CYSTS, STRUCTURAL
ONLY RADIOLOGICAL FEATURE IS
COLLAPSE AND FRAGMENTATION ARE
CHONDROCALCINOSIS.
RECOGNIZED FEATURES.
● ACUTE ATTACKS : SEEN ONLY ON ●
CROWN DENSE SYNDROME – CTGOUT
MRI /CT NOT ON RADIOGRAPHS.
AT THE AT.AX. JOINT CAUSES CORD
● CHRONIC ARTHROPATHY : AFFECTS COMPRESSION
PATELLOFEMORAL ARICULATION ● CS SPINE – INTERVETEBRAL DISC
MOST COMMONLY
CALCIFICATION , JOINT SPACE
●
RADIOCARPAL,CARPOMETACARPAL NARROWING AND
AND ELBOW COMMONLY INVOLVED ●
SI JT – OSTEOARTHRITIC CHANGES
●
CHONDROCALCINOSIS FREQUENTLY ● SYMPHYSIS PUBIS – THIN VERTICAL
BUT NOT INVARIABLY PRESENT
LINEAR CALCIFICATION SEEN
●
ARTHROPATHY : B/L SYMETRICAL
DISTRIBUTION
AVASCULAR NECROSIS OF HIP
● HIP IS THE MC AFFECTED PART
IN AVN
● STAGE 2: XRAY-FEMORAL HEAD
● CAUSE : ELDERLY – TRAUMATIC SPHERICAL. DIFFUSE
ESPECIALLY SUBTROCHANTERIC OSTEOPOROSIS AND SUBSEQUENT
FRACTURE. YOUNG – NON SCLEROSIS. MRI -'DOUBLE
TRAUMATIC EG: LEG CALVE LINE'.
PERTHES
● STAGE 3:XRAY -LATERAL VIEW-
● INVESTIGATION OF CHOICE :MRI FEMORAL HEAD LOSES SPHERICAL
– MORE SENSITIVE THAN CT OR SHAPE. MRI- LOW SIGNAL LINE
SCINTI. IN ALL SEQUENCES PARALLEL TO
SUBARTICULAR CORTEX
● STAGING AND MRI
INDICATING SUBCHONDRAL
FEATURES:STAGE 0 : FRACTURE.THIS PRECES HEAD
ASYMPTOMATIC ,DIAGNOSED WHEN COLLAPSE.JOINT SPACE
C/L SYMPTOMATIC HIP IS MAINTAINED.
AFFECTED.MRI -MARROW EDEMA
● STAGE 4: COLLAPSE,
● STAGE 1: XRAY:FEMORAL HEAD DESTRUCTION OF CARTILAGE AND
SPHERICAL .MINOR JOINT SPACE NARROWING.
OSTEOPOROSIS ,TRABECULAE
NORMAL.MRI – 'DOUBLE LINE'
DEMARCATION BETWEEN NORMAL
AND ABNORMAL BONE.
1.XRAY- GOUT
● 1ST MTP
JT
AFFECTED
ILIOPSOAS BURSITIS N SUFE
● ILIOPSOAS BURSITIS
●
COMMONEST BURSA AROUND ●
SLIPPED UPPER FEMORAL
THE HIP TO GIVE A SOFT TISUE EPIPHYSES
MASS
●
OCCURS IN ADOLECENTS AND
●
COMMUNICATES W ITH THE JOINT
YOUNG CHILDREN
IN 15% OF INDIVIDUALS.
●
SLIP IS USUALLY POSTERIOR
●
LIES BETW EEN THE ILIOPSOAS
MUSCLE AND HIP CAPSULE AND ●
XRAY – FROG LATERAL SHOWS
LATERAL TO FEMORAL VESSELS THE SLIP
●
BECOMES ENLARGED IN OA AND ●
MRI SHOWS SECONDARY
RA PROCESSES , OTHERW ISE AVASCULAR NECROSIS OF
REMAINES A COLLAPSED FEMORAL HEAD AT
STRUCTURE PRESYMPTOMATIC STAGE
●
C/F : PAIN , SW ELLING AND
NEUROPATHY DUE TO
COMPRESSION OF ADJACENT
FEMORAL NERVES
MENISCAL TEARS
●
MRI MODALITY OF CHOICE , ●
BUCKET HANDLE TEAR
ARTHROGRAPHY ALSO USED . ●
IN CASES OF VERTICAL TEARS
●
T1,T2 AND PROTON DENSITY ●
THE FREE OF TEAR MAY
SHOW TEARS
DISLODGE INTO JOINT SPACE.
●
NORMAL MENISCI IS BOW TIE ●
THIS MAY BREAK OFF ON BOTH
SHAPED ON SAGITTAL VIEW
SIDES AND BECOME A
OF MRI WITH LOW SIGNAL
FRAGMENT
INTENSITY
●
THIS FRAGMENT USUALLY
●
TEARS APPEAR AS HIGH
GETS LODGED IN THE INTER-
SIGNAL WITH IN THE
CONDYLAR NOTCH.
MENISCUS BECAUSE OF
IMBIBED SYNOVIAL FLUID ●
MEDIAL MENISCUS MORE
COMMONLY INVOLVED
●
DEGENERATIVE TEARS
APPEAR AS HIGH SIGNAL ON ● C/F - LOCKED KNEE OR
HORIZONTAL LESIONS INABILITY TO EXTEND KNEE
MAY OCCUR.
●
TRAUMATIC TEARS APPEAR AS
VERTICAL HIGH SIGNAL
LESIONS
MRI – NORMAL MENISCI
● NORMAL “BOW TIE”
APPEARANCE OF
THE MENISCUS
MRI – DEGENERATED TEARS
● ARROW
INDICATING FULL
THICKNESS TEAR
OF MEDIAL
MENISCUS
● HIGH INTENSITY
SIGNAL SPANNING
THE FULL
THICKNESS OF
MENISCUS
ANTERIOR CRUCIATE LIGAMENT TEARS
● DOES NOT EXIST IN ISOLATION ● PARTIAL OR INCOMPLETE
DISRUPTIONS MAY BE ASSOCIATED
● ASSO WITH MENISCL TEARS IN 68% OF WITH ATTENUATION OF SOME
ACUTE INJURIES AND 91% OF FASCICLES WHICH MAY APPEAR
CHRONIC INJURIES INDISTINCT DUE TO ADJACENT
OEDEMA AND HEMORRHAGE.
● COLLATERAL LIGAMENT INJURY
COMMON ACCOMPANYING FINDING ● SECONDARY SIGNS INCLUDE A
BUNCHING UP OF THE POSTERIOR
● C/F – PAINFUL KNEES + ACUTE
CRUCIATE LIGAMENT , ANTERIOR
HEMARTHROSIS
TRANSLATION OF FEMUR ON TIBIAL
● NORMAL ACL IS REPRESENTED AS CONDYLES AND A WAVY PATELLAR
ONE OR MORE BANDS OF LOW LIGAMENT, ALTHOUGH THESE ARE
SIGNAL INTENSITY AND SEPARATE NOT SPECIFIC.
FIBRE BUNDLES CAN BE ● ABSENCE OF ACL IN BOTH SAGITTAL
DISTINGUISHED NEAR THE POINT OF
AND CORONAL PLANE IS DIAGNOSTIC
ATTACHMENT DUE TO INTERPOSITION
OF FAT BETWEEN THEM ● SEGOND FRACTURE -
POSTEROLATERAL TIBIAL FRACTURE
● COMPLETE TEAR – DISCONTINUITY IN
AND FRATURE OF LATERAL FEMORAL
LOW SIGNAL BAND IS PRESENT
CONDYLE ARE RELATIVELY SPECIFIC
FOR ACUTE COMPLETE ACL TEARS
T2W MRI -ACUTE ACLTEAR
● Acute tear of the
ACL manifest as
focal interruption of
the ligament. T2-
weighted image
shows focal
hyperintense edema
and/or fluid
involving the
proximal ACL
ACHILLES TENDON RUPTURE
● LARGEST AND STRONGEST TENDON ●
MRI FINDINGS OF
IN THE HUMAN BODY TENDINOSIS:DIFFUSE SWELLING OR
● FORMED BY COMMON INSERTION OF THICKENING WITH INCREASED SIGNAL
SOLEUS, PLANTARIS AND ON T2 AND STIR.
GASTROCNEMIUS ● SAGITTAL IMAGES WILL DEMONSTRATE
● INJURIES COMMONLY SEEN IN INCRESED CONVEXITY ANTERIORLY
MIIDDLE AGED MEN AND OEDEMA WITH KAGER'S FAT
TRIANGLE OR RETROCALCANEAL
● COMONLY ASSOCIATED WITH BURSA.
SPORTING ACTIVITIES ● PARTIAL TEAR : LINEAR FOCAL REGIONS
● PREDISPOSING FACTORS : OF INCREASED SIGNAL
DEGENERATION DUE TO DIABETES
MELLITUS , GOUT , RHEUMATOID
● COMPLETE TEAR : INCREASED SIGNAL
ARTHRITIS AND OTHER CONNECTIVE ON T2 BETWEEN ENDS OF THE TORN
TISSUE DISORERS LIGAMENT.
●
NOT ROUTINELY EVALUATED THE ONLY MODALITY OF
W ITH INJURIES INVESTIGATION
●
USUALLY LATERAL LIGAMENTS ●
NOW ULTRASOUND AND MRI ARE
INVOLVED PREFERRED.
●
LATERAL LIGAMENTS INCLUDE
ANTERIOR AND POSTERIOR
TALOFIBULAR LIGAMENTS AND
CALCANEOFIBULAR LIGAMENTS
●
GRADE 1 SPRAIN – STRETCHING
AND TEARING OF ANTERIOR
TALO FIBULAR BUNDLE
●
GRADE 2 SPRAIN – TEARING OF
ANTERIOR TALOFIBULAR AND
STRETCHING OF CALCANEO
FIBULAR
●
GRADE 3 SPRAIN – DISRUPTION
OF ALL THREE LIGAMENTS
ROTATOR CUFF INJURIES
●
MRI FINDINGS :PARTIAL THICKNESS
●
MUSCLES OF THE ROTATOR CUFF TEARS : NOT VISIBLE EARLY . THEN
INCLUDES 1.SUPRASPINATUS BECOME VISIBLE WHEN TEAR
2.INFRASPINATUS ENLARGES
3.SUBSCAPULARIS AND 4.TERES ● FULL THICKNESS TEARS ; VISIBLE AS
MINOR INCREASED SIGNAL ON PROTON
DENSITY AND T1 AND T2 SEQUENCES
●
TYPES OF ROTATOR CUFF AND WHICH CROSSES THE FULL
INJURIES ON ARTHROGRAPHY THICKNESS OF THE ROTATOR CUFF
ARE TYPE 1: DEGENERATION AND TENDON.
TENDINOSIS W ITHIN TENDON BUT ●
SECONDARY SIGNS OF FULL
NOT VISIBLE ON THE SURFACE THICKNESS TEARS INCLUDES FLUID IN
THE SUBACROMIAN AND SUBDELTOID
●
TYPE 2: PARTIAL THICKNESS BURSA AND SUBACROMIAN
ROTATOT CUFF TEARS ARE SUBDELTOID PERIBURSAL FAT AND
PRESENT ; THESE MAY BE FATTY ATROPHY OF ROTATOR CUFF
INTRASUBSTANCE OR MAY OPEN MUSCLES
ON TO SUPERIOR AND INFERIOR ● MRI GIVES INFO ABOUT THE CAUSE
SURFACES. OF THE IMPINGEMENT OR TEAR SUCH
AS SOFT TISSUE SWELLINGS , SPURS
●
TYPE 3: FULL THICKNESS ETC.
ROTATOR CUFF TEAR W ITH
COMMUNICATION BETW EEN
● SUBSCAPULARIS AND TERES MINOR
TEARS OCCUR MOSTLY AS PART OF
SUBACROMIAN AND SUBDELTOID GLOBAL CUFF TEARS AND NOT IN
BURSA AND SHOULDER JOINT. ISOLATION.
1.MRI – NORMAL ROTATOR
CUFF
● NORMAL SIGNAL
OF ROTATOR
CUFF
2.MRI – FULL THICKNESS
TEARS
● MRI SHOWS
INCREASED
SIGNAL ON
PROTON DENSITY
AND T1 AND T2
SEQUENCES AND
WHICH CROSSES
THE FULL
THICKNESS OF
THE ROTATOR
CUFF TENDON.
3.MRI – PARTIAL THICKNESS
RC INJURY
● PARTIAL
THICKNESS
TEARS : NOT
VISIBLE EARLY .
THEN BECOME
VISIBLE WHEN
TEAR ENLARGES
GLENOHUMERAL INSTABILITY
● MRI AXIAL SEQUENCES
● BONY CONTOUR OF GH JT IS ● T1W SEQ – CHANGES IN SUB-
INTRINSICALLY UNSTABLE AND
CHONDRAL BONE.
THEREFORE THE STABILITY DEPENDS
UPON THE MUSCULAR , TENDINOUS ● T2W SEQ – EVALUATING
AND CAPSULAR STRUCTURES THAT CARTILAGENOUS LABRUM
ARE RELATED TO THE JOINT .
● HILLSACK'S LESION – FEMORAL HEAD
●
COMMONEST INSTABILITY – ANTERIOR WITH POSTEROLATERAL COMPRESSION
INSTABILITY FRACTURE. SEEN IN SINGLE OR
RECURRENT SHOULDER DISLOCATIONS
● ASSOCIATED WITH INJURIES TO
LABRUM AND INFERIOR ● POSTERIOR INSTABILITY – DUE TO
GLENOHUMERAL LIGAMENT AND POSTERIOR BAND OF THE INFERIOR
LABRUM GLENOHUMERAL LIGAMENT
● INVESTIGATION OF CHOICE: MR OR CT ● REVERSE HILLSACK'S LESION –
ARTHROGRAPHY COMPRESSION FRACTURE OF THE
ANTERIOR ASPECT OF THE HUMERAL
● COMMON FINDINGS : AVULSION OF HEAD
ANTERIOR LABRUM WITH OR WITHOUT
FRACTURE INVOLING THE
UNDERLYING INFERIOR GLENOID RIM –
BANKARD LESION
HILL SACHS LESION
● FRACTURE OF
THE POSTERO
SUPERIOR PART
OF THE FEMORAL
HEADN – SHOW
BY ARROWS
FROZEN SHOULDER
● TRIDENT
FINGERS
4.XRAY – ACP
● TUBULAR BONES
ARE SHORT ,
BROAD
● WIDENING OF
METAPHYSIS
SEEN