R. Botchu

• MBBS, MS (ortho), MRCSI, MRCSEd, FRCR
• Consultant at Royal Orthopedic hospital, Birmingham, UK

Musculoskeletal disorders (MSDs) represent a broad spectrum of diseases and injuries that significantly affect the musculoskeletal system and impose a considerable burden on global public health. This review focuses on the landscape of MSD diagnoses and emphasizes the high prevalence of these conditions. Additionally, it recognizes the inadequacies...

Objectives Lateral ankle pain can be caused by a variety of pathologies, including those involving the peroneal tendons. The spatial arrangement of the peroneal tendons within the trimalleolar groove remains underexplored in the literature. The objective of this study is to propose a new classification to describe and categorize the spatial relatio...

Mirror image artefact is a beam path artefact that occurs when the transmitted ultrasound beam and returning echo reflect off a highly reflective surface and change direction before returning to the transducer. This reflection alters the direction of the returning echoes. The ultrasound software interprets this as a duplicated structure across the...

Bone tumours affecting the hand and wrist are rare, making up for less than 5% of all bone tumours. Primary bone tumours are especially uncommon when compared with tumours arising in the soft tissues of the hand; Haber described 2321 tumours of the hand with only 38 cases involving bone.

Aims Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global...

Primary malignant bone tumours can pose significant diagnostic and therapeutic challenges due to inter-tumour heterogeneity. While traditional imaging modalities such as radiography, MRI (magnetic resonance imaging), and CT (computed tomography) remain essential for initial evaluation and staging, emerging evidence underscores the evolving role of...

Ulnar-sided wrist pain is a common presenting clinical complaint and can present a diagnostic challenge for the treating physicians. Though individual pathologies of the dorsal cutaneous branch of ulnar nerve (DCBUN) and extensor carpi ulnaris (ECU) tenosynovitis can give rise to ulnar side wrist pain, we report an unusual distal impingement of the...

Background Congenital block vertebrae (BV) is a common condition resulting from segmentation disorders during embryonic development, leading to the fusion of adjacent vertebrae. BV at C2–C3 (cervical vertebrae 2 nd –3 rd ) level is the most common segmentation anomaly. Labeling this correctly is the requirement for exact labeling of the spine. Diag...

Sensor-based technology uses either embedded or surface-wearable devices to detect physical (such as pressure, speed, acceleration, and force), chemical (such as ions), and biological signals, which, integrated with information and communications technology (ICT), provide a way of analyzing these signals. The Industry 4.0 revolution, the developmen...

Background CAM morphology of the hip is a disorder of abnormal morphology of the femoral head–neck junction associated with loss of the osseous sphericity of the femoral head. Several radiological measurements exist to detect CAM morphology of the hip. Objectives The aim of the study was to evaluate the precision and efficacy of a new BROH CAM offs...

Background and Aim The process of manuscript submission and review in academic publishing is multifaceted, with figures playing a crucial role in communicating research findings effectively. However, the precise impact of these visual elements on reviewer perceptions and manuscript acceptance remains underexplored. This study aims to investigate th...

This edition of the Imaging of the shoulder simplifies the complex field of musculoskeletal imaging.

Shoulder injuries are a common occurrence among both professional and recreational athletes, particularly affecting those involved throwing and racquet sports, and sports where repetitive overhead movements are required such as swimming and baseball (pitchers). They can significantly impact an athlete’s performance and career, resulting in time awa...

The spine serves as a protective, load-bearing, and stabilizing axis for the body. Trauma can cause significant damage to spinal structures, potentially resulting in severe neurological dysfunction and disabilities such as paraplegia or quadriplegia. Early and accurate diagnosis of these injuries is important, with computed tomography and magnetic...

Intelligent Wearable and implanted health monitoring devices based on ST has power ful potential to alter the future of healthcare service across the world. Apart from preven tion, diagnosis and management of medical conditions, it is destined to play a pivotal role in monitoring patients in a variety of in-hospital and ambulatory settings. Sensor-...

Objective To describe a novel, simple technique to increase the diagnostic accuracy of computed tomography (CT) guided bone biopsy. This is to ensure the adequacy of the histopathological specimen and avoid suboptimal samples. Materials and Methods The sandwich technique (ST) involves retaining the pathological sample between two slabs of normal b...

Introduction A locked knee may limit mobility and quality of life, significantly affecting their quality of life. This article investigates the common causes of locked knee and emphasizes the need for appropriate diagnosis and treatment. Materials and Methods This study analyzed 267 knee magnetic resonance imaging (MRI) who presented with knee loc...

Plain radiographs of the shoulder joint are the most commonly used first-line imaging method for the evaluation of shoulder-related issues, even in the era of advanced imaging techniques. This chapter aims to illustrate the positioning techniques of the various radiographic projections commonly used to evaluate the shoulder joint, structures seen i...

The quadriceps muscles are a large group of four muscles in the anterior compartment of the thigh, comprising the rectus femoris, vastus medialis, vastus intermedius and vastus lateralis, which in combination act as the primary extensors of the knee joint. The rectus femoris is also responsible for hip joint flexion. Quadriceps muscle injuries are...

Interventional procedures for the wrist and hand have become essential tools in the management of a variety of musculoskeletal conditions, including tendinopathies, joint disorders, and soft tissue pathologies. Advancements in imaging modalities—ultrasound, fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI)—have improved pr...

Objectives This case report aims to describe an extremely rare instance of isolated distal iliotibial band (ITB) rupture due to tuberculosis (TB), a condition that is seldom seen in clinical practice. The goal is to highlight the diagnostic challenges, ultrasound findings and the successful treatment of this condition in a non-athlete patient with...

Iliopsoas bursitis, although not rare, may manifest clinically as a detectable mass in the groin area. This condition has the potential to apply pressure on the adjacent femoral neurovascular bundle, leading to isolated mononeuropathy. We present an uncommon case of femoral mononeuropathy in a 46-year-old female patient caused by an enlarged iliops...

History A 78-year-old male presented with a past history of high-grade right-sided pelvic chondrosarcoma for which he had previously undergone right hindquarter amputation. This had subsequently metastasized to the lumbar spine and he required radiotherapy and excision of paravertebral disease. Several years later, he presented with double incontin...

A limp is an abnormal, uneven or laboured gait typically resulting from pain, weakness, or structural deformity involving the hip, lower limb, spine or abdominopelvic abnormalities. Limps in children are common and have diverse causes that can be benign to life-threatening including trauma, congenital malformations, and neoplastic diseases. Diagnos...

Background and Aims Spondylolysis refers to a stress fracture of the pars interarticularis. We investigated if there is a correlation between a novel measurement, the sagittal pars inclination angle and the incidence of spondylolysis (pars defect) in adolescent and young adult patients. Methods A retrospective cohort study was conducted at the Roy...

Ultrasound imaging of the shoulder joint has become an increasingly valuable diagnostic tool in evaluating shoulder joint pathology due to its accessibility, cost-effectiveness, and the ability to provide real-time, dynamic assessment. The shoulder, being a highly mobile and complex joint, is prone to a variety of musculoskeletal disorders, includi...

Introduction: Sarcomas are a large group of malignant mesenchymal tumors. Despite being rare diseases, the disease burden of these malignant tumors on the existing healthcare infrastructure is substantial. Although previous bibliometric studies have analyzed the trends of publications on osteosarcoma and Ewing’s sarcoma, no such major analyses enco...

Background/Objectives: Intraneural tumors (INTs) pose a diagnostic challenge, owing to their varied origins within nerve fascicles and their wide spectrum, which includes both benign and malignant forms. Accurate diagnosis and management of these tumors depends upon the skills of the radiologist in identifying key imaging features and correlating t...

The scapulothoracic joint (STJ) is a non-synovial articulation between the scapula and chest wall and is supported by surrounding soft tissue, muscles, and bursae. It functions with acromioclavicular joint and associated ligaments to provide stability and enable various shoulder motions, including lifting and overhead activities, in coordination wi...

Image-guided shoulder interventions have emerged as essential tools in the management of common shoulder complaints, necessitating a comprehensive understanding of the complex shoulder anatomy and the relevant imaging modalities. Fluoroscopy and ultrasound are the primary imaging techniques, each tailored to specific procedural goals, with fluorosc...

Musculoskeletal image-guided interventional radiology plays a key role in diagnosing and treating a range of conditions. Recent advances have yielded a wide variety of procedures that can be applied selectively and enable the personalisation of patient care. This review aims to outline the indications, applications, and techniques of subspecialist...

The pectoralis major and pectoralis minor are part of the anterior axio-appendicular musculature and are essential for shoulder and upper arm movement, aiding in activities such as pushing, lifting, and throwing. With the rise in weight training and sports, pectoralis major injuries have become more common. Understanding the complex tendo anatomy o...

Objectives An update of the first European Society of Musculoskeletal Radiology (ESSR) consensus on soft tissue tumor imaging in 2015 became necessary due to technical advancements, further insights into specific entities, and the revised WHO classification (2020) and AJCC staging system (2017). The third part of the revised guidelines covers algor...

Background and Aims This study examines whether the level of the conus medullaris affects the incidence of cerebrospinal fluid (CSF) leaks in spinal surgery. Material and Methods Retrospective analysis was performed on 55 patients who had suffered from CSF leaks post-operatively. The data was stratified by spinal pathology, age, and sex using pati...

Introduction Climate change and global warming have major contributions from greenhouse gas emissions. Despite the introduction of digitalized systems, many health care systems still rely heavily on paper. The purpose of this study is to investigate paper usage in the radiology department of a single hospital institution over the last 3 years to fo...

A reference text guide for Imaging of the Hip & Bony Pelvis: Techniques and Applications

Peripheral nerve imaging is a powerful tool in evaluating peripheral neuropathy. This review aims to provide an overview of the anatomy, clinical significance and pathologies of small peripheral nerves, typically less than 2 mm in diameter. High frequency ultrasound probes offer the best assessment of these nerves whilst permitting real-time clinic...

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radio...

Muscle hernias are relatively uncommon, with most cases reported in the leg involving the tibialis anterior muscle. However, hernias can affect other muscles in both the upper and lower limbs. Here, we present the first documented case of nontraumatic deltoid muscle hernia. An 80-year-old woman presented to the outpatient department with soft tissu...

Hydroxyapatite deposition disease is a common musculoskeletal pathology that often affects rotator cuff tendons in the shoulder joint. Here, we present the first documented case of acute calcific enthesitis involving the lateral patellar retinaculum, specifically the lateral patellofemoral ligament (LPFL). A 35-year-old male presented with insidiou...

Tumors and tumorlike lesions around the shoulder girdle present significant diagnostic and therapeutic challenges due to the complex interplay of anatomy, varied tumor types, and their diverse radiographic appearances. This chapter provides a comprehensive review of the current strategies for the detection, characterization, and staging of these le...

Background: Advances in digital technology have led to widespread availability of digital devices and consequent increased usage amongst across the population including practising healthcare professionals. Increased ‘Digital Screen time’ and its effect on physical, psychological health, and sleep patterns has been predominantly evaluated in child...

Objectives Hip pain, secondary to labral tears (LT), can significantly impact the quality of life in the young adult population. LTs can be an incidental finding or can arise from underlying pathology, most commonly from femoroacetabular impingement (FAI). The cause of hip pain in young adults can represent a diagnostic challenge to clinicians. Mag...

Background and Aims Dupuytren’s contracture is a prevalent, hereditary fibroproliferative disorder affecting the palmar aponeurosis, which can resemble various neoplastic and non-neoplastic disorders of the hand. This resemblance poses a diagnostic challenge for healthcare professionals. This observational study aims to evaluate the range of condit...

Background Groin pain is a complex musculoskeletal condition, causing significant difficulty in its diagnosis and management. The stability of the anterior pelvis is maintained by the formation of a complex fibrous aponeurotic plate by the rectus abdominis and adductor longus tendons. It is, therefore, vital to have a comprehensive understanding of...

Introduction Anterior knee pain is not an uncommon problem. A plethora of pathologies can cause anterior knee pain. Patellofemoral maltracking (trochlear dysplasia) is not an uncommon cause of anterior knee pain in adolescents and young adults. Aim We hypothesize that there is an alteration of articular cartilage of the patella and trochlear in tr...

Background The exploration of Chat generative pre-training transformer’s (GPT’s) applications in medicine is gaining momentum, with artificial intelligence, particularly ChatGPT, showing promise in enhancing orthopedic care. ChatGPT can assist clinicians by providing relevant information based on patient symptoms, medical history, and radiological...

Background Magnetic resonance imaging (MRI) arthrography has been a mainstay in the diagnosis of musculoskeletal (MSK) joint-related pathology for decades. With the advent of MRI and further advancements incorporating powerful magnetic fields, the radiological landscape is undergoing a shift. The objective of this study is to evaluate the relevance...

Objective Inflammation in patients with myositis would increase diffusion of water molecules across sarcolemma that could be detected with the help of diffusion tensor imaging (DTI). We aimed to determine an association between DTI of vastus lateralis (VL) and histopathological findings in cases of myositis and to estimate diagnostic performance of...

Adductor canal (Hunter’s canal) pathologies are often underdiagnosed, with the saphenous nerve being the most commonly affected. While uncommon, involvement of the femoral artery and vein can cause severe and irreversible complications if not detected early. Significant attention must be given to adductor canal pathologies because the musculoaponeu...

Superficial venous pseudoaneurysm is rare. Prompt diagnosis is essential to formulate management plan and decrease morbidity. We describe a novel Eccentric Ripple sign of BAARISh for diagnosing venous pseudoaneurysm.

Intra-articular lipoma of the hip joint is a rare entity with a mere 4 cases being reported to date We present two patients with true intra-articular hip lipomas, with insidious onset of non-traumatic hip pain and gradual restriction in the range of motion. Magnetic Resonance Imaging (MRI) revealed an encapsulated intra-articular lesion with the ty...

Background and Aims Pelvic bone tumours are rare, with a guarded prognosis despite advances in radiological imaging and surgical techniques. Despite this, limb salvage surgery has become the mainstay treatment for patients presenting with primary bone sarcomas, especially those with low histological grade variants. However, the rate of peri-operati...

Arthritis of the hip and sacroiliac joint (SIJ) presents a complex challenge in diagnostic imaging and management. This chapter provides a comprehensive review of the current imaging modalities employed in the evaluation of hip and SIJ arthritis, with an emphasis on the latest advancements and clinical applications. The role of various imaging tech...

Hip and pelvic pain is a commonly reported symptom in primary and secondary care. Radiological percutaneous intervention offers many diagnostic and therapeutic alternatives to invasive orthopedic surgery. The authors review both the common and advanced percutaneous techniques including the indications, specific anatomy, and approaches to ensure a s...

Background Calcific myonecrosis (CMN) is a rare condition, often considered to be a late sequela of antecedent trauma. Case Report We describe here our experience in managing a 56-year-old male referred with a painless swelling on the lateral aspect of the left lower leg with a suspicion of a tumour. Results Clinical and imaging features were cla...

Evaluation of glenoid bone loss following recurrent anterior shoulder dislocations is normally performed using cross sectional imaging. To assess how anteroposterior (AP) and Bernageau view radiographs compare to computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy for evaluating glenoid bone loss in patients with recurrent an...

Introduction and Aims Grade 1 spondylolisthesis can be challenging to detect on magnetic resonance imaging (MRI), particularly for spinal surgeons and radiologists with limited experience interpreting spinal MRIs. This study aims to describe a unique sign described as a “mustache sign,” which may assist in detecting subtle Grade I spondylolisthesis...

Background A healthy lower back is essential for optimal spinal function and overall wellness. Magnetic resonance imaging (MRI) has become the gold standard in assessing lumbar spine disease. This article aims to evaluate the precision and efficacy of the lumbar offset distance (LOD) as a novel MRI parameter designed to determine the lumbar spine a...

Cricket is the second most popular spectator sport in the world after football, with an estimated fan base of 2.5 billion people and played professionally or semi-professionally in 108 countries. In the past two decades, with the establishment of newer formats such as Twenty-20, along with the traditional tests and one-day matches, there has been a...

The pediatric shoulder joint is affected by a multitude of congenital and developmental disorders, which may occur in isolation or be a part of a greater spectrum of disorders. In young patients, accurate and timely identification is paramount for effective management. Appropriate imaging is thus crucial for prognostication and improved patient out...

Introduction A plethora of pathologies can cause medial ankle pain. Material and methods We present a case of 66-year-old male with medial ankle pain. Result Bilateral CTEV (Congenital talipes equino varus) with impingement between the navicular and medial malleolus was present, which was contributing to medial ankle pain. Conclusion One needs t...

Background and Aims Plain film radiography is the first imaging modality in the detection of most foreign bodies. However, it is not sensitive for detection of radiolucent objects such as organic material including plant thorns. Case report Herein, we present the case of a 19-year-old male patient, presenting with an 8-month history of right knee...

Pathologies of the scapulothoracic articulation may lead to painful symptoms such as crepitus and bursitis. While conservative treatments are preferred, persistent symptoms may require image-guided injections. This study aims to determine the optimal hand positioning during ultrasound to maximize the distance between the scapula and thoracic wall,...

The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine th...

Groin pain following hip arthroplasty has a spectrum of aetiologies. Although mild post-operative pain at six months to a year is common, other causative factors should be considered where pain is severe or persistent. The rectus femoris (RF) muscle is the most common of the quadriceps tendons to be injured or strained. Pathologies are known to occ...

Painful os peroneum syndrome (POPS) is one of the uncommon causes of lateral foot pain in orthopaedic practice. POPS encompasses a spectrum of pathologies such as an acute or a chronic fracture, peroneus longus tenosynovitis, and attrition or partial rupture of the peroneus longus tendon. Herein, we reported the first case of POPS secondary to hydr...

Background Isolated tumours affecting the coccyx are infrequent, with only a handful of documented cases in the literature. Herein, we highlight the most extensive consecutive case series involving various isolated coccyx tumours with varied clinical presentations and imaging features. Material and Methods A retrospective search of our tertiary Or...

Background Magnetic resonance imaging (MRI) is key in evaluating central cartilage tumors. The BACTIP (Birmingham Atypical Cartilaginous Tumour Imaging Protocol) protocol assesses central cartilage tumor risk based on the tumor size and degree of endosteal scalloping on MRI. It provides a management protocol for assessment, follow-up, or referral o...

Isolated spontaneous tears in the non-insertional portion of the iliopsoas tendon without any underlying injury are uncommon, especially among elderly individuals. We describe the case of an 88-year-old man who experienced right groin pain caused by a spontaneous non-insertional tear in the iliopsoas tendon identified through ultrasound and confirm...

Osteopetrosis is a rare genetic disorder, which often presents with excessively dense bones, yet paradoxically weak that are prone to fractures as seen in our patient. Currently, there is no proven cure, and treatment focuses on managing symptoms and complications like fractures. In our patient, bony union was achieved after open reduction and inte...

The skeleton of the lower torso is a strong yet flexible scaffold composed of the sacrococcygeal spine, pelvic girdle, and hip joints, whose individual components can undergo a multitude of possible injuries following either low- or high-energy traumas. Plain and cross-sectional imaging play key roles in the early detection of skeletal injuries, an...

Stress fractures about the hip and bony pelvis are increasingly recognized among certain cohorts but can pose a diagnostic challenge. The hip joint is a common location for pain in the general population, as well as in athletes where stress fractures can mimic other musculotendinous injuries about the hip. There are many risk fractures for stress f...

Objectives The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms o...

For pelvic and hip pathology, radiographic evaluation can prove to be a relatively quick and inexpensive first line of imaging. Care should be taken to limit the exposure to X-radiation in accordance with as low as reasonably practicable (ALARP) principle, and appropriate gonadal shielding should be used whenever possible. There are various radiogr...

The introduction of the xxxxxxxx (GIBPS) technique represents a patient-centric novel and innovative method of ultrasound guided corticosteroid injection targeting the Glenohumeral joint (GHJ) and the Subacromial-Subdeltoid (SASD) bursa in a sequential manner, in the same setting. By integrating the two different sites of injection into a single te...

Objectives Pes planus, or “flat foot,” is a common foot condition involving talus misalignment, calcaneus eversion, medial arch collapse, and forefoot abduction. It is a well-recognized cause of foot pain and can lead to disability in patients. Clinical diagnosis is supported by plain radiography. However, in patients presenting with foot pain, tra...