0:01

<v ->To finish up this particular segment,

0:03

I'll just show you pictures that have indicated

0:07

perhaps plica in other joints.

0:10

I don't know, these have to be uncommon.

0:13

This is from an article, not too long ago,

0:15

showing you a plica within the glenohumeral joint.

0:20

They are reported they're infrequent.

0:22

They're usually located posteriorly.

0:25

And this one sent to me recently

0:27

from a previous visiting scholar showing you

0:30

what might be a plica or called a plica

0:33

involving the radio aspect of the radiocarpal compartment.

0:38

I'm gonna finish up in the last

0:39

just couple of minutes talking briefly about the ankle

0:43

and plica as part of a bigger picture of ankle impingement.

0:49

There are a lot of articles that have talked

0:51

about impingement about the ankle.

0:52

And in fact, impingement can occur in all the quadrants

0:55

of the ankle, anteroposterior medial lateral,

1:00

oblique angles as well, both above the joint,

1:04

at the joint level or even below it.

1:06

But the most press has been with regard

1:09

to this anterolateral ankle impingement,

1:13

generally related to problems with this ligament,

1:18

which is the anterior talofibular ligament.

1:21

And when you go ahead and look at it there,

1:23

if you read the articles,

1:24

there are various causes for impingement

1:27

and pain related to this area,

1:29

which can include just thickening of the ligament itself,

1:34

okay, or some scar tissue or fibrous tissue associated

1:40

with the thickened ligament.

1:43

And I'm showing you examples of patients

1:45

who all had had chronic tears of these lateral ligaments,

1:49

and came in with pain and restricted motion.

1:52

So you'll hear about impingement syndromes.

1:55

I've listed some of the causes of them

1:58

as you can see for this particular location,

2:01

the anterolateral aspect of the ankle joint.

2:05

And I just wanted to include this case,

2:07

'cause it was sent to me recently from a visiting scholar

2:09

from Brazil that there are other things

2:12

that produce ankle impingement,

2:14

and one of them known as footballer's ankle relates

2:17

to a very peculiar pattern of bone proliferation

2:21

or osteophyte formation that dominates

2:23

on the anteromedial aspect of the talus.

2:27

And in fact, can be missed on standard lateral radiographs

2:30

of the ankle.

2:31

Oblique films are better or oblique projections are better.

2:35

But this was a dramatic example of a soccer player

2:40

who had this anterior or anteromedial ankle impingement

2:48

related to this large epidermis foam growth arising

2:52

from the dorsal surface of the talus.

2:56

So with that, we've reached the end

2:57

of the lecture portion of this day one.

3:00

And we'll continue on now with the cases,

3:04

so the fourth segment of cases.