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<v ->So, first

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I'd like to thank Dr. Resnick

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for the invitation to be a part of his team.

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It's an honor to be here with him,

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with the other Brazilian speakers,

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with the MRI Online team.

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I'm very...

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It's been

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a lot of work,

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to put this,

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to put this course online.

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And I'm a 100% sure that we'll have a good time together

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and this conference will provide more skills

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and it will improve your confidence,

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the confidence of the audience dealing

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with musculoskeletal radiology.

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So, that's it.

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Let's get started with the cases.

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And this is the first case that I'd like to show you today.

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It's a case, it's a 29-year-old male,

0:58

professional soccer player

1:00

with chronic pain on the

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pubis and an acute pain on the proximal veroduct

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of the left thigh

1:11

that started 20 days ago after a training session.

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And we can see a complete tear of the rectus femoris here,

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in this area.

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Let me, let me put a key here.

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We can see a complete tear of the rectus femoris here,

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with a distal retraction at the level

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of the myotendinous junction right here,

1:33

and fluid filling the gap.

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But, I haven't brought this case to show this right now.

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What I wanna show you today is this lesion right here,

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is this lesion here,

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osteitis pubis and more some

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in tear of the adductor tendons near to the

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symphysis pubis.

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And let's first take a look on the findings

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of the osteitis pubis that we have here.

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We can see subchondral bone sclerosis.

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Let me put here the T1 image.

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T1 and T2 fat stat images, the deep fat stat images.

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We can see subchondral sclerosis

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and also you can see marginal osteophytes,

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some areas of bone marrow edema

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particularly on the right side.

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And also you can see medullary

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fat infiltration

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around the joint telling us that this is a chronic process.

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And now I'd like to show you here

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the primary and the secondary cleft sign.

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Here we have the primary cleft sign.

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That was one of the clefts that Dr. Resnick

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had showed in his previous lecture.

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And here we have the second secondary cleft sign.

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Remember, the primary cleft sign it's a normal finding.

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We can find that in the patients,

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in the symptomatic patients,

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but the secondary cleft sign here

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that's not a normal finding.

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This is a finding.

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We can appreciate that the secondary cleft sign

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when we have lesions of the adductor tendons.

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Here we have lesion of the right adductor tendon

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of the left adductor tendon.

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And we can see that lesion, it's also going up.

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The lesion is going to the

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upon the roses of the hetero sub-abdominals

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here in this area.

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So here we can also appreciate in the axial plane

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the secondary clef sign on the right side.

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We also have a little bit

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of the secondary clef sign on the left side,

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but most of the lesion is located on the right side.

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Another

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thing that we can appreciate

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in this case is that the secondary clef sign also goes

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posteriorly to the area of the gracilis origin.

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And to complete this peak,

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the picture of this case to complete the case,

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you can also see fibrotic changes on the

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abductor tunnel of the right side.

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You can see some calcifications in this area right here.

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I can show here better.

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There are some calcifications in this area as well.

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And before I closed this case, I finished this case.

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This is our first case.

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And I just want to say that these operations,

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they are very common in soccer players as well,

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other sports like that involve excessive twisting

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and turning movements like tennis, basketball,

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hockey and about the soccer players,

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some researchers have shown that the abductor dysfunction

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and the tears of the abductor tendons,

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they can come first before before

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the osteitis pubis.

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And in some cases,

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this abductor dysfunction and tear is more, it's a more

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a common cause of algia

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than osteitis pubis itself.

5:32

And I don't know though, if you wanna talk a little bit

5:35

about this case, if you have some.

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<v ->Just one point that I would make, you know,

5:39

in some of the original articles that came out about this,

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they actually injected the synthesis pubis.

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Sounds pretty painful to me.

5:49

I don't know if you did any injections

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at all to show the abnormal clefs.

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<v ->Yeah, I, we, I don't know.

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I don't do injections since geography here, but I saw some

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of these papers and they sometimes they

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classify the different types of the secondary clef sign.

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And based on this classification,

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they predict what patients will improve with the

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court cards, injections

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and the ones that will not improve

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with the court card injections.

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<v ->Right. Well, it's a beautiful case.

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Thank you.

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<v ->Okay. Thank you very much.

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Let's go to a second case now.