Interactive Transcript
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So here is a 38-year-old gal with repetitive
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microtrauma because she's a personal
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trainer who's complaining of lateral
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pain, rule out iliofemoral ligament tear.
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And we've got the strong, powerful
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iliofemoral ligament laterally.
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It's also anterior, preventing
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anterior hip dislocation.
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It's one of the reasons why we
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almost always dislocate out the back.
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And it has a firm, tight attachment
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to the acetabular cortex.
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There's no fluid separating
0:35
the ligament from the underlying acetabulum.
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So that isn't her problem.
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What is masquerading as an iliofemoral
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ligament tear as we move posterior is this
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mass-like, proteinaceous, water single intensity
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mass that is essentially a pseudocyst.
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Mucoid material surrounded by
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fibrous tissue, but not lined by
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synovium or cuboidal epithelium.
1:03
Now a pseudocyst can occur as a result
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of a ganglion from mucoid degeneration
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or degeneration of a capsule.
1:12
It can come through a labrum
1:14
as in a paralabral cyst.
1:16
It can come out of the sheath of a tendon.
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When you're around a ball and socket joint and
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you see proteinaceous water signal intensity
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under pressure, it is almost always associated
1:30
with a labral tear, whether you see it or not.
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So there's a labral tear present here.
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You can bet on it.
1:39
And here it is.1 00:00:00,500 --> 00:00:04,700 So here is a 38-year-old gal with repetitive
0:04
microtrauma because she's a personal
0:06
trainer who's complaining of lateral
0:08
pain, rule out iliofemoral ligament tear.
0:12
And we've got the strong, powerful
0:16
iliofemoral ligament laterally.
0:18
It's also anterior, preventing
0:21
anterior hip dislocation.
0:22
It's one of the reasons why we
0:24
almost always dislocate out the back.
0:27
And it has a firm, tight attachment
0:31
to the acetabular cortex.
0:32
There's no fluid separating
0:35
the ligament from the underlying acetabulum.
0:38
So that isn't her problem.
0:40
What is masquerading as an iliofemoral
0:43
ligament tear as we move posterior is this
0:47
mass-like, proteinaceous, water single intensity
0:51
mass that is essentially a pseudocyst.
0:55
Mucoid material surrounded by
0:57
fibrous tissue, but not lined by
0:59
synovium or cuboidal epithelium.
1:03
Now a pseudocyst can occur as a result
1:07
of a ganglion from mucoid degeneration
1:10
or degeneration of a capsule.
1:12
It can come through a labrum
1:14
as in a paralabral cyst.
1:16
It can come out of the sheath of a tendon.
1:19
When you're around a ball and socket joint and
1:23
you see proteinaceous water signal intensity
1:26
under pressure, it is almost always associated
1:30
with a labral tear, whether you see it or not.
1:35
So there's a labral tear present here.
1:36
You can bet on it.
1:39
And here it is.
1:40
Let's go to our water-weighted image and scroll.
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And when we do, we see a hyperintense
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signal running vertically, way too deep,
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and longitudinally, and one on the opposite
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side that happens to be asymptomatic.
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Which, by the way, is not an uncommon event.
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In an overuse athlete.
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The reason the one on the right is
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symptomatic is because of the large
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paralabral cyst associated with it.
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Now she'll probably develop a cyst on the
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opposite side because you can see a little
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bit of inflammation and a little bit of
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synovial fluid that has extended outside
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the labrum and is running along the side.
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It's just not under pressure yet.
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If you look at the image.
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It's very hard to identify a nice dark
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labrum, but this wouldn't be the sequence
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that you would search for a labral tear on.
2:36
You would be more interested in the overall
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morphology of the head and the neck,
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which, by the way, is over-tapered, and the
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configuration of the acetabulum and the roof.
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Relative to the head.
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So, this is an individual with bilateral labral
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tears, symptomatic on the right, masquerading
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clinically as an iliofemoral ligament injury,
2:58
and in the axial projection, we do see not
3:01
just one cyst, but actually another smaller
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cyst anteriorly on the right, and maybe even
3:06
a little tiny one starting to brew on the left
3:10
as a manifestation of this patient's bilateral
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labral tears, but the labral tears themselves
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were only seen in the coronal projection.
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Let's take on another case, shall we?
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