0:00

With that, uh, said, it's my privilege now to introduce

0:05

my senior colleague, right?

0:07

And that is Minnie Patria.

0:09

And I have to tell you a little bit about Minnie Patria was

0:13

previous chief of the division of Musculoskeletal image.

0:16

Uh, she, uh, has a worldwide

0:21

reputation, uh, not only as a musculoskeletal imager,

0:25

but is having the best eyes.

0:28

All right? So she picks up things that I don't see

0:32

and certainly picks up a lot of things

0:33

that I only see later on.

0:36

So I was very useful for her early on in her training.

0:41

I would use her to pick up the abnormalities,

0:43

and I would be able to discuss them better than she.

0:47

But now she doesn't need me at all.

0:49

She picks up the abnormalities

0:51

and she discusses them

0:53

in a very professor like, uh, fashion.

0:56

Uh, she is professor of, uh, uh, radiology

1:00

here at UCSD,

1:02

and as I said, uh, we've been together for a few decades,

1:07

and I very much appreciate having her on the faculty.

1:11

So, Minnie, you're gonna talk about something, by the way,

1:14

that I never talk about because I, I rely on you for this.

1:18

You're gonna talk about tendons

1:20

and ligaments about the pelvis and hip,

1:23

and you're also, I guess,

1:24

gonna talk a bit about the synthesis.

1:26

Pubis, thank you for participating in the course. Vinny,

1:31

Uh, thank you for inviting me.

1:33

And, uh, the eyes are not what they used to be.

1:36

The eyes need glasses now.

1:39

Um, but, uh, I, uh, appreciate, uh,

1:42

very much your kind words,

1:43

and we have worked together for an extremely long time,

1:45

and it's been my privilege to be able to say

1:48

that I have been working with you now for over 30 years.

1:53

So, uh, that's been a real highlight of my career.

1:57

Um, I will be lecturing on the soft tissues of the pelvis,

2:02

focusing on pel uh, tendons.

2:04

The discussions of bony abnormalities

2:07

and, uh, femoral acetabular impingement will, uh, follow.

2:12

So I always found the tendons really overwhelming when I

2:15

started doing MR Imaging.

2:18

My usual approach to any area that I image is

2:20

to talk about the bones first, do the joints,

2:23

and then move to soft tissues.

2:25

And just the number of tendons in this area can be

2:28

very overwhelming.

2:29

So what I've found works best for me is

2:32

to divide up the tendons according to their function.

2:36

And I've listed the five major functions of the hip.

2:39

I haven't included internal rotation because it's so minor.

2:43

And those tendons are, uh, really predominantly designed

2:46

to do other things.

2:48

So if you look at these five functions,

2:51

you can see the tendons that I have listed,

2:53

and I'm gonna be going through these systematically

2:57

with you, uh, starting with abduction

2:59

and marking our way, uh, finally into the posterior groups

3:03

and external rotation.

3:05

Now, in terms of anatomy, I think the best way

3:09

to approach these is to think about these

3:11

as four superficial groups and one deep group.

3:15

The superficial groups are going to consist of the adductors

3:19

and flexors, and then abductors

3:21

and extensors shown here at two different pelvic levels.

3:25

The deep group is the external rotators,

3:27

and it's worthwhile keeping in mind

3:29

that this is a deep group,

3:31

and it's actually very challenging for the clinicians

3:33

to palpate these tendons.

3:36

And so symptoms are often vague

3:38

and they may not actually suspect pathology

3:41

of the external rotators.

3:43

Another thing to keep in mind is

3:45

that when we look at musculoskeletal imaging,

3:48

that thinking in a slice fashion doesn't really help you

3:51

to understand the anatomy of most of the joints.

3:55

And it's better off to think of this in terms of layers.

3:59

So I like to look at these by working my way

4:02

around the pelvis rather than slicing front to back.

4:05

So I start by looking at the synthesis.

4:08

I do the adductors,

4:09

and I work my way around these on the axial images.

4:14

And then after I do the extensors, move deep

4:17

to do the external rotators.

4:19

And that you can do it very, very efficiently

4:22

by holding your axial on one screen

4:25

and then putting the other planes that you like

4:27

to look at on the other screen

4:29

and just going around systematically.