Skip to main content
SpringerLink
Log in

Signs in Musculoskeletal Radiology

  • Chapter
  • First Online:
Classic Imaging Signs

  • 869 Accesses

Abstract

Radiology is considered as becoming an original and important field of modern art. Indicative signs are useful to recognize pathologies and to narrow the list of differential diagnoses. In orthopaedics, many radiologic findings are named for the natural phenomena that they mimic. The radiologic signs in orthopaedics whose names are based on phenomena or observations in the natural world are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jin HA, Yim SJ, Yu SS, Ko TS, Lee JH. The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus. Knee. 2014;21(1):129–32.

    Article  Google Scholar 

  2. Haramati N, Staron RB, Rubin S, Shreck EH, Feldman F, Kiernan H. The flipped meniscus sign. Skelet Radiol. 1993;22(4):273–7.

    Article  CAS  Google Scholar 

  3. Fujikawa A, Amma H, Ukegawa Y, Tamura T, Naoi Y. MR imaging of meniscal malformations of the knee mimicking displaced bucket-handle tear. Skelet Radiol. 2002;31(5):292–5.

    Article  Google Scholar 

  4. Nguyen JC, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 2014;34(4):981–99.

    Article  Google Scholar 

  5. Helms CA, Laorr A, Cannon WD. The absent bow tie sign in bucket-handle tears of the menisci in the knee. AJR Am J Roentgenol. 1998;170(1):57–61.

    Article  CAS  Google Scholar 

  6. Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am. 2007;45(6):1033–vii. https://doi.org/10.1016/j.rcl.2007.08.009.

  7. Terzidis IP, Christodoulou A, Ploumis A, Givissis P, Natsis K, Koimtzis M. Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation. Am J Sports Med. 2006;34(7):1170–5.

    Article  Google Scholar 

  8. Dunoski B, Zbojniewicz AM, Laor T. MRI of displaced meniscal fragments. Pediatr Radiol. 2012;42(1):104–12.

    Article  Google Scholar 

  9. Vaishya R, Vijay V, Vaish A, Agarwal AK, Ghonge NP. Double posterior cruciate ligament sign on magnetic resonance imaging: imaging variants, mimics, and clinical implications. J Orthop Case Rep. 2017;7(6):76–9.

    Google Scholar 

  10. Facchetti L, Schwaiger BJ, Gersing AS, et al. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years. Eur Radiol. 2017;27(8):3499–508.

    Article  Google Scholar 

  11. Cha J, Choi SH, Kwon JW, et al. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skelet Radiol. 2012;41(8):997–1002.

    Article  Google Scholar 

  12. Bradley DM, Bergman AG, Dillingham MF. MR imaging of cyclops lesions. AJR Am J Roentgenol. 2000;174(3):719–26.

    Article  CAS  Google Scholar 

  13. Vahey TN, Hunt JE, Shelbourne KD. Anterior translocation of the tibia at MR imaging: a secondary sign of anterior cruciate ligament tear. Radiology. 1993;187(3):817–9.

    Article  CAS  Google Scholar 

  14. Chiu SS. The anterior tibial translocation sign. Radiology. 2006;239(3):914–5.

    Article  Google Scholar 

  15. Kijowski R, Sanogo ML, Lee KS, et al. Short-term clinical importance of osseous injuries diagnosed at MR imaging in patients with anterior cruciate ligament tear. Radiology. 2012;264(2):531–41.

    Article  Google Scholar 

  16. Guenoun D, Le Corroller T, Amous Z, Pauly V, Sbihi A, Champsaur P. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagn Interv Imaging. 2012;93(5):331–41.

    Article  CAS  Google Scholar 

  17. McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Skelet Radiol. 2001;30(6):312–5.

    Article  CAS  Google Scholar 

  18. Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop. 2012;46(5):561–5.

    Article  Google Scholar 

  19. Mao Y, Dong Q, Wang Y. Ganglion cysts of the cruciate ligaments: a series of 31 cases and review of the literature. BMC Musculoskelet Disord. 2012;13:137.

    Article  Google Scholar 

  20. Camacho MA. The double posterior cruciate ligament sign. Radiology. 2004;233(2):503–4.

    Article  Google Scholar 

  21. Vaishya R, Vijay V, Vaish A, Agarwal AK, Ghonge NP. Double posterior cruciate ligament sign on magnetic resonance imaging: imaging variants, mimics, and clinical implications. J Orthop Case Rep. 2017;7(6):76–9.

    Google Scholar 

  22. Venkatanarasimha N, Kamath A, Mukherjee K, Kamath S. Potential pitfalls of a double PCL sign. Skelet Radiol. 2009;38(8):735–9.

    Article  Google Scholar 

  23. Kerimaa P, Väänänen M, Ojala R, et al. MRI-guidance in percutaneous core decompression of osteonecrosis of the femoral head. Eur Radiol. 2016;26(4):1180–5.

    Article  Google Scholar 

  24. Manenti G, Altobelli S, Pugliese L, Tarantino U. The role of imaging in diagnosis and management of femoral head avascular necrosis. Clin Cases Miner Bone Metab. 2015;12(suppl 1):31–8.

    Google Scholar 

  25. Karantanas AH, Drakonaki EE. The role of MR imaging in avascular necrosis of the femoral head. Semin Musculoskelet Radiol. 2011;15(3):281–300. https://doi.org/10.1055/s-0031-1278427.

  26. Narayanan A, Khanchandani P, Borkar RM, et al. Avascular necrosis of femoral head: a metabolomic, biophysical, biochemical, electron microscopic and histopathological characterization. Sci Rep. 2017;7(1):10721.

    Article  CAS  Google Scholar 

  27. Gondim Teixeira PA, Savi de Tové KM, Abou Arab W, et al. Subchondral linear hyperintensity of the femoral head: MR imaging findings and associations with femoro-acetabular joint pathology. Diagn Interv Imaging. 2017;98(3):245–52.

    Article  CAS  Google Scholar 

  28. Spaeth HJ, Abrams RA, Bock GW, et al. Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Radiology. 1993;188(2):553–6.

    Article  CAS  Google Scholar 

  29. Clavero JA, Alomar X, Monill JM, et al. MR imaging of ligament and tendon injuries of the fingers. Radiographics. 2002;22(2):237–56.

    Article  Google Scholar 

  30. Simerjit Singh M, Pai DR, Avneet K, Ruchita D. Injury to ulnar collateral ligament of thumb. Orthop Surg. 2014;6(1):1–7.

    Article  Google Scholar 

  31. Lee J, Papakonstantinou O, Brookenthal KR, Trudell D, Resnick DL. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skelet Radiol. 2003;32(11):619–27.

    Article  Google Scholar 

  32. Yoo JH, Bo KY, Ryu HK. Lateral epicondylar femoral avulsion fracture combined with tibial fracture: a counterpart to the arcuate sign. Knee. 2008;15(1):71–4.

    Article  Google Scholar 

  33. Snyder SJ, Karzel RP, Del Pizzo W, et al. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.

    Article  CAS  Google Scholar 

  34. Tuite MJ, Cirillo RL, De Smet AA, et al. Superior labrum anterior-posterior (SLAP) tears: evaluation of three MR signs on T2-weighted images. Radiology. 2000;215(3):841–5.

    Article  CAS  Google Scholar 

  35. Boutin RD, Marder RA. MR imaging of SLAP lesions. Open Orthop J. 2018;12:314–23.

    Article  Google Scholar 

  36. Symanski JS, Subhas N, Babb J, et al. Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-analysis. Radiology. 2017;285(1):101–13.

    Article  Google Scholar 

  37. Fritz EM, Pogorzelski J, Hussain ZB, Godin JA, Millett PJ. Arthroscopic repair of humeral avulsion of the glenohumeral ligament lesion. Arthrosc Tech. 2017;6(4):e1195–200.

    Article  Google Scholar 

  38. Rebolledo BJ, Nwachukwu BU, Konin GP, Coleman SH, Potter HG, Warren RF. Posterior humeral avulsion of the glenohumeral ligament and associated injuries: assessment using magnetic resonance imaging. Am J Sports Med. 2015;43(12):2913–7.

    Article  Google Scholar 

  39. Chung CB, Sorenson S, Dwek JR, Resnick D. Humeral avulsion of the posterior band of the inferior glenohumeral ligament: MR arthrography and clinical correlation in 17 patients. AJR Am J Roentgenol. 2004;183(2):355–9.

    Article  Google Scholar 

  40. Brennan D, O’Connell MJ, Ryan M, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.

    Article  Google Scholar 

  41. Byrne CA, Bowden DJ, Alkhayat A, Kavanagh EC, Eustace SJ. Sports-related groin pain secondary to symphysis pubis disorders: correlation between MRI findings and outcome after fluoroscopy-guided injection of steroid and local anesthetic. AJR Am J Roentgenol. 2017;209(2):380–8.

    Article  Google Scholar 

  42. Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: X-ray clue to a significant knee instability. Am J Sports Med. 1979;7(1):27–33.

    Article  CAS  Google Scholar 

  43. Stallenberg B, Gevenois PA, Sintzoff SA Jr, Matos C, Andrianne Y, Struyven J. Fracture of the posterior aspect of the lateral tibial plateau: radiographic sign of anterior cruciate ligament tear. Radiology. 1993;187(3):821–5.

    Article  CAS  Google Scholar 

  44. Albtoush OM, Horger M, Springer F, Fritz J. Avulsion fracture of the medial collateral ligament association with Segond fracture. Clin Imaging. 2019;53:32–4.

    Article  Google Scholar 

  45. Alyas F, Tirabosco R, Cannon S, Saifuddin A. “Fallen fragment sign” in Langerhans’ cell histiocytosis. Clin Radiol. 2008;63(1):92–6.

    Article  CAS  Google Scholar 

  46. Killeen KL. The fallen fragment sign. Radiology. 1998;207(1):261–2.

    Article  CAS  Google Scholar 

  47. Park JS, Ryu KN. Hemophilic pseudotumor involving the musculoskeletal system: spectrum of radiologic findings. AJR Am J Roentgenol. 2004;183(1):55–61.

    Article  Google Scholar 

  48. Cai JH, Gan LF, Zheng HL, Li H. Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture. Pediatr Radiol. 2005;35(10):995–7.

    Article  Google Scholar 

  49. Ni B, Li M. The effect of children’s gluteal muscle contracture on skeleton development [article in Chinese]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2007;38(4):657–77.

    Google Scholar 

  50. Rai S, Meng C, Wang X, et al. Gluteal muscle contracture: diagnosis and management options. SICOT J. 2017;3:1.

    Article  Google Scholar 

  51. Meldon SW, Hargarten SW. Ligamentous injuries of the wrist. J Emerg Med. 1995;13(2):217–25.

    Article  CAS  Google Scholar 

  52. Sulkers GSI, Strackee SD, Schep NWL, Maas M. Wrist cineradiography: a protocol for diagnosing carpal instability. J Hand Surg Eur Vol. 2018;43(2):174–8.

    Article  CAS  Google Scholar 

  53. Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology. 1992;184(3):855–8.

    Article  CAS  Google Scholar 

  54. Pao DG. The lateral femoral notch sign. Radiology. 2001;219(3):800–1.

    Article  CAS  Google Scholar 

  55. Kanakamedala AC, Burnham JM, Pfeiffer TR, et al. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1399–405.

    Article  Google Scholar 

  56. Lysack JT, Fenton PV. Variations in calcaneonavicular morphology demonstrated with radiography. Radiology. 2004;230(2):493–7.

    Article  Google Scholar 

  57. Crim JR, Kjeldsberg KM. Radiographic diagnosis of tarsal coalition. AJR Am J Roentgenol. 2004;182(2):323–8.

    Article  Google Scholar 

  58. Czuczman GJ, Mandell JC, Khurana B. Iliopsoas bursal extension of lipohemarthrosis: a novel imaging finding associated with hip fracture. Skelet Radiol. 2017;46(2):253–7.

    Article  Google Scholar 

  59. Lugo-Olivieri CH, Scott WW Jr, Zerhouni EA. Fluid–fluid levels in injured knees: do they always represent lipohemarthrosis? Radiology. 1996;198(2):499–502.

    Article  CAS  Google Scholar 

  60. Goswami GK. The fat pad sign. Radiology. 2002;222(2):419–20.

    Google Scholar 

  61. DeFroda SF, Hansen H, Gil JA, Hawari AH, Cruz AI Jr. Radiographic evaluation of common pediatric elbow injuries. Orthop Rev (Pavia). 2017;9(1):7030.

    Article  Google Scholar 

  62. Blumberg SM, Kunkov S, Crain EF, Goldman HS. The predictive value of a normal radiographic anterior fat pad sign following elbow trauma in children. Pediatr Emerg Care. 2011;27(7):596–600.

    Article  Google Scholar 

  63. Murphy JS, Mubarak SJ. Talocalcaneal coalitions. Foot Ankle Clin. 2015;20(4):681–91.

    Article  Google Scholar 

  64. Brown RR, Rosenberg ZS, Thornhill BA. The C sign: more specific for flatfoot deformity than subtalar coalition. Skelet Radiol. 2001;30(2):84–7.

    Article  CAS  Google Scholar 

  65. Lateur LM, Van Hoe LR, Van Ghillewe KV, Gryspeerdt SS, Baert AL, Dereymaeker GE. Subtalar coalition: diagnosis with the C sign on lateral radiographs of the ankle. Radiology. 1994;193(3):847–51.

    Article  CAS  Google Scholar 

  66. Moraleda L, Gantsoudes GD, Mubarak SJ. C sign: talocalcaneal coalition or flatfoot deformity? J Pediatr Orthop. 2014;34(8):814–9.

    Article  Google Scholar 

  67. Banks KP. The target sign: extremity. Radiology. 2005;234(3):899–900.

    Article  Google Scholar 

  68. Jee WH, Oh SN, McCauley T, et al. Extraaxial neurofibromas versus neurilemmomas: discrimination with MRI. AJR Am J Roentgenol. 2004;183(3):629–33.

    Article  Google Scholar 

  69. Wasa J, Nishida Y, Tsukushi S, et al. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. AJR Am J Roentgenol. 2010;194(6):1568–74.

    Article  Google Scholar 

  70. Srinivasan S, Krishnan V, Ali SZ, Chidambaranathan N. “Swirl sign” of aggressive angiomyxoma–a lesser known diagnostic sign. Clin Imaging. 2014;38(5):751–4.

    Article  Google Scholar 

  71. Benson JC, Gilles S, Sanghvi T, Boyum J, Niendorf E. Aggressive angiomyxoma: case report and review of the literature. Radiol Case Rep. 2016;11(4):332–5.

    Article  Google Scholar 

  72. Choi JA, Lee KH, Jun WS, Yi MG, Lee S, Kang HS. Osseous metastasis from renal cell carcinoma: “flow-void” sign at MR imaging. Radiology. 2003;228(3):629–34.

    Article  Google Scholar 

  73. Chen SC, Kuo PL. Bone metastasis from renal cell carcinoma. Int J Mol Sci. 2016;17(6):987.

    Article  CAS  Google Scholar 

  74. Salapura V, Zupan I, Seruga B, Gasljevic G, Kavcic P. Osteoblastic bone metastases from renal cell carcinoma. Radiol Oncol. 2014;48(3):243–6.

    Article  Google Scholar 

  75. Mitra I, Duraiswamy M, Benning J, Joy HM. Imaging of focal calvarial lesions. Clin Radiol. 2016;71(4):389–98.

    Article  CAS  Google Scholar 

  76. Goosens V, Vanhoenacker FM, Samson I, Brys P. Longitudinal cortical split sign as a potential diagnostic feature for cortical osteitis. JBR-BTR. 2010;93(2):77–80.

    CAS  Google Scholar 

  77. Krasnokutsky MV. The button sequestrum sign. Radiology. 2005;236(3):1026–7.

    Article  Google Scholar 

  78. Buckley B, Chan VO, Mitchell DP, et al. The clothes maketh the sign. Insights Imaging. 2016;7(4):629–40.

    Article  Google Scholar 

Suggested Readings for this Chapter

  • Guglielmi G, Nasuto M. Emergency and trauma in MSK radiology. Semin Musculoskelet Radiol. 2017;21(3):165–6.

    Article  Google Scholar 

  • Lefevre N, Naouri JF, Herman S, Gerometta A, Klouche S, Bohu Y. A current review of the meniscus imaging: proposition of a useful tool for its radiologic analysis. Radiol Res Pract. 2016;2016:8329296.

    Google Scholar 

  • Leggit JC, McLeod G. MSK injury? Make splinting choices based on the evidence. J Fam Pract. 2018;67(11):678–83.

    Google Scholar 

  • Marinković S, Stošić-Opinćal T, Tomić O. Radiology and fine art. AJR Am J Roentgenol. 2012;199(1):W24–6.

    Article  Google Scholar 

  • Math KR, Berkowitz JL, Paget SA, Endo Y. Imaging of musculoskeletal infection. Rheum Dis Clin N Am. 2016;42(4):769–84.

    Article  Google Scholar 

  • Tagliafico AS, Isaac A, Bignotti B, Rossi F, Zaottini F, Martinoli C. Nerve tumors: what the MSK radiologist should know. Semin Musculoskelet Radiol. 2019;23(1):76–84.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Haitao Yang

  2. Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China

    Lingling Song & Zhaoshu Huang

Authors
  1. Haitao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lingling Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhaoshu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haitao Yang .

Editor information

Editors and Affiliations

  1. Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China

    Bo Gao

  2. Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA

    Alexander M. McKinney

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yang, H., Song, L., Huang, Z. (2021). Signs in Musculoskeletal Radiology. In: Gao, B., McKinney, A.M. (eds) Classic Imaging Signs. Springer, Cham. https://doi.org/10.1007/978-3-030-56348-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-56348-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-56347-9

  • Online ISBN: 978-3-030-56348-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation