SYNOPSIS: This article is intended for the clinician charged with either diagnosing or treating patients with lower extremity symptoms thought to be of musculoskeletal etiology. It gives a brief overview of the imaging techniques that can be utilized, common pathology, and certain pearls and pitfalls that may be encountered in both ordering and interpreting lower extremity magnetic resonance imaging. While we cannot present a comprehensive discussion of all of the known disorders in the lower extremity, we will choose common disorders to illustrate the diagnostic benefits and limitations of magnetic resonance imaging and provide reasons for choosing certain magnetic resonance imaging techniques.

J Orthop Sports Phys Ther 2011;41(11):873-886. doi:10.2519/jospt.2011.3713

KEY WORDS: diagnosis, medical imaging, MRI

The patient was an 87-year-old woman referred to a physical therapist for right buttock and lateral calf pain of insidious onset that had been present for the past 3 weeks. She also complained of a 5-day history of right anterior hip/groin pain. Due to concern for a recent fracture of the right hip or pelvis, based on prior radiographs and the patient's medical history, radiographs were ordered that demonstrated new superior and inferior right pubic rami fractures. An orthopaedic surgeon was immediately consulted who diagnosed the patient with insufficiency fractures of the right pubic rami. The patient was instructed on toe touch weight bearing with a walker for the right lower extremity, and the orthopaedic surgeon recommended treatment by the physical therapist, as well as a reevaluation of the current management strategies for the patient's osteoporosis.

J Orthop Sports Phys Ther 2010;40(10):666. doi:10.2519/jospt.2010.0416

KEY WORDS: hip, osteoporosis, pelvis, radiographs

The patient was a 23-year-old woman referred to physical therapy for the primary treatment of knee pain which began 4 months prior following a twisting injury. During the patient interview, the patient also complained of neck pain and numbness and tingling in her bilateral hands and feet which began 6 weeks earlier after jumping into a 2 meter pool head first and striking her head on the floor of the pool. Due to concern over a serious cervical spine injury, the physical therapist focused his initial physical examination on the patient's cervical spine. Physical examination findings were remarkable for midline cervical spine tenderness and decreased sensation throughout both hands and feet. Cervical spine radiographs were ordered, which revealed a cortical irregularity along the anterior aspect of the superior endplate of the C7 vertebral body, which was concerning for an anterior-superior compression fracture. Computed tomography scanning was completed for further evaluate the area of injury and revealed minimally displaced anterior compression fractures within the C7, T1, T2, and T3 vertebral bodies. Due to the paresthesias in the upper and lower extremities, magnetic resonance imaging was completed, which demonstrated no evidence for significant central canal or foraminal stenoses. The patient was referred to a neurosurgeon who recommended conservative management.

J Orthop Sports Phys Ther 2010;40(3):189. doi:10.2519/jospt.2010.0405

KEY WORDS: computed tomography, magnetic resonance imaging, neck pain, radiographs