MSK RADIOLOGY FOR PHYSIOTHERAPIST

1 Dr. Asmaa A. Alshamy, MD

 Ankle joint
imaging

Dr. Asmaa Alshamy,MD

Lecturer of Radiodiagnosis, faculty of
medicine, Zagazig university
 Anatomy
(Bones)
AP mortis
lateral
view
 Ankle fractures (Weber classification)
Weber A
(below tibiofibular syndesmosis)
• Transverse fracture of lateral
malleolus or rupture of LCL
• Oblique fracture of medial
malleolus or rupture of deltoid
ligament
• Tibiofibular ligament complex
spared (stable)
• Results from supination-
adduction (inversion)
 Ankle fractures (Weber classification)
Weber B
(through tibiofibular syndesmosis)
• Oblique or spiral fracture of lateral
malleolus near the joint
• Transverse fracture of medial
malleolus or rupture of deltoid
ligament
• Partial disruption of tibiofibular
ligament complex
• Results from supination-lateral
rotation or pronation-abduction
Ankle fractures (Weber classification)
Weber C
(above tibiofibular syndesmosis)
• Proximal fracture of fibula
• Transverse fracture of medial
malleolus or rupture of deltoid
ligament
• Rupture of tibiofibular ligament
complex (lateral instability)
• Results from pronation-lateral
rotation
Ankle fractures (Weber classification)
 Pilon fracture

• A comminuted
supramalleolar distal
tibial fracture extending
into the tibial plafond ▶
it is caused by axial
loading and impaction of
the talar dome against
the tibial plafond (driving
the fragments apart) ▶
it is associated with
distal fibular fractures
Calcaneal fracture(Lovers fracture)
A comminuted impaction fracture within the body of
the calcaneus with flattening of the subtalar portion
of bone
▶ it is usually due to a compressive force (e.g. a fall
from a height) ▶ it is commonly associated with
lumbar spinal compression fractures or pilon
fractures
• Boehler’s angle: the normal angle is between 20 and
40
▶ an impacted fracture will reduce this
angle
 Calcaneal
fracture(Lovers
fracture)
Calcaneal stress fracture
 Posterior compartment
(Achilles tendon(
Achilles Tendon is
formed by the
confluence of the
gastrocnemius and
the soleus tendon.

✓ The critical zone,

the site of most
tears, is 2 to 6 cm
proximal to its
calcaneal insertion
site.
 Posterior compartment
(Achilles tendon(
• Plain radiographs show marked soft tissue
Swelling with obliteration of the pre-Achilles fat
pad.

Kager’s fat pad

 Posterior compartment
(Achilles tendon(
MRI
• Partial tears shows tendon enlargement
and edema, intratendinous areas of increased
signal intensity on T2W, and surrounding soft
tissue edema.
• Complete tear; a tendinous gap is present and
is filled with high signal blood and edema.
 Partial tear

Complete
tear
Achilles tendinosis \tendinitis
Chronic degeneration which can preceed a tear
MRI :Diffuse tendon swelling and thickening ▶
T2WI( Intermediate SI(
Achilles Tendinosis progress to partial tear

Sagittal T2WI Shows

thickening of Achilles
tendon (intermediate
SI) with partial
thickness tear (high SI )
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