Soft Tissue, Tendon, and Ligamentous Injuries on Ultrasound and MRI — WACS Viva & Clinical Scenarios (Musculoskeletal and Trauma Imaging)

Exam-style soft tissue, tendon, and ligamentous injuries on ultrasound and mri viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 42-year-old athlete presents with acute shoulder pain and inability to abduct the arm following trauma. Describe the high-resolution ultrasound and multiplanar magnetic resonance imaging (MRI) criteria used to differentiate partial-thickness from full-thickness rotator cuff tears, detailing the classification systems used to assess tendon retraction and muscle quality.
• SCENARIO 2: A 28-year-old footballer experiences a non-contact pivoting injury to the right knee accompanied by an audible pop and rapid joint effusion. Detail the primary direct and secondary indirect MRI signs of an anterior cruciate ligament (ACL) rupture, and explain the imaging features that distinguish an unstable bucket-handle meniscal tear from an uncomplicated degenerative tear.
• SCENARIO 3: A 35-year-old runner presents with acute posterior ankle pain and a palpable defect after a sudden push-off maneuver. Detail the dynamic ultrasound protocol and MRI findings for evaluating Achilles tendon rupture versus severe tendinosis, including key measurements and anatomical structures that must be documented for surgical planning.
• SCENARIO 4: A 24-year-old skier sustains a hyperabduction injury to the first metacarpophalangeal (MCP) joint. Outline the ultrasound and MRI features of an ulnar collateral ligament tear, describe the pathophysiological mechanism and diagnostic criteria of a Stener lesion, and explain why this alters management.
• SCENARIO 5: A 30-year-old male presents with a painful, enlarging soft-tissue mass in the anterior thigh following a blunt sports injury three weeks earlier. Discuss the multi-modality imaging characteristics of myositis ossificans across its evolutionary stages, highlighting key features that prevent misdiagnosis as an aggressive soft-tissue sarcoma.