Linking orthopaedics and radiology - the plain film revisited: the upper limb

22 SEPTEMBER 2014

LINKING ORTHOPAEDICS AND RADIOLOGY II THE PLAIN FILM REVISITED: THE UPPER LIMB Venue: British Dental Association, London CPD: 5 CREDITS

BIR Annual Congress 2014: 22-23 October, London

Welcome and thank you for coming to the ‘Linking Orthopaedics and radiology II - the plain film revisited: the upper limb’ event organised by the British Institute of Radiology.

This booklet contains the abstracts and biographies for each speaker.

This meeting has been awarded 5 RCR category I CPD credits.

CPD certificates will be distributed by email within two weeks of the meeting once the online delegate survey has been completed.

Please complete the online delegate survey using the below link. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/theupperlimb We hope you find the day interesting and enjoyable.

Adam Mitchell Meeting Organiser

We are most grateful to

for supporting this conference

Programme 09:30 Registration and refreshments 10:00 Welcome and introduction

Dr Adam Mitchell, Consultant Radiologist,

Chelsea and Westminster Hospital Session 1 Chair: Dr Gajan Rajeswaren, Consultant Radiologist, Chelsea and Westminster Hospital 10:15

Shoulder joint replacement and complications Dr Ian Pressney, Consultant Radiologist Mr Addie Majed, Upper Limb Orthopaedic Fellow Royal National Orthopaedic Hospital

11:00

Shoulder trauma - what the surgeon needs to know Dr Monica Khanna, Consultant Radiologist Dr Peter Reilly, Consultant Surgeon Imperial College

11:45 Radiographic findings in the shoulder, elbow and wrist with age

and normal variants

Dr Subhasis Basu, Consultant Radiologist, Salford Royal NHS Foundation Trust

Mr Rupen Dattani, Consultant Orthopaedic Surgeon, Chelsea and

Westminster Hospital 12:30 Lunch Session 2 Chair: Dr Ben Roberton, Consultant Radiologist, Chelsea and Westminster Hospital 13:30

The wrist Dr Richard Goodwin, Consultant Radiologist Mr Adrian Chojnowski, Consultant Orthopaedic and Trauma Surgeon, Norfolk and Norwich Hospital

14:30 The hand and fingers

Mr Max Horwitz, Consultant Surgeon

Dr Ben Roberton, Consultant Radiologist, Chelsea and Westminster Hospital 15:30 Case review

Dr Warren Davis, Consultant Radiologist, Ipswich Hospital 16:15 Close of meeting

Please remember to complete the online delegate survey using the below link: https://www.surveymonkey.com/s/theupperlimb Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

BIR Annual Congress 2014: 22-23 October, London

Speaker profiles Dr Subhasis Basu Consultant Radiologist, Salford Royal NHS Foundation Trust Subspecialty interest : Musculoskeletal Radiology Graduating from Barts and the London School of Medicine and Dentistry in 2006, he completed his radiology training from Manchester followed by a Musculoskeletal Radiology Fellowship at Chelsea and Westminster Hospital, London. He was appointed as Consultant Musculoskeletal Radiologist at Salford Royal Hospital NHS Foundation Trust in 2014.

He has published and presented at National and International meetings.

Adrian Chojnowski Consultant Orthopaedic Surgeon, Norfolk and Norwich Hospital Adrian Chojnowski is a Consultant Orthopaedic Surgeon with special interest in hand and wrist at the Norfolk and Norwich University NHS Foundation Trust Hospital. He works closely with the four consultant musculoskeletal radiologists at the Trust where a weekly upper limb x-ray meeting occurs.

Combined publications include imaging of the TFCC, midcarpal instability, phalangeal fractures and radiological perspectives of acute hand injuries.

Mr Rupen Dattani Consultant Orthopaedic Surgeon, Chelsea and Westminster Hospital Mr Rupen Dattani gained his medical degree from the University of Wales and completed his Orthopaedic training on the South West Thames specialist registrar programme. He obtained a doctorate of medicine (MD) in orthopaedics at University College London. He was awarded two prestigious fellowships in shoulder and elbow surgery, one working with Mr Graham Tytherleigh-Strong in Cambridge and the other at the internationally renowned Reading Shoulder Unit working with Professor Ofer Levy. He has also completed a trauma fellowship at a Level I trauma centre in Vancouver, Canada. These fellowships have provided him with a highly specialised clinical practice, exclusively in shoulder and elbow arthroscopic (keyhole) and arthroplasty (joint replacement) surgery as well as surgery for fractures around the shoulder and elbow joints.

Mr Dattani has always had a strong research ethic and believes that the high quality of medical care we enjoy today has only been achieved through well controlled research. He has published over 20 articles in peer reviewed journals and has presented his work at both national and international conferences. His main research interests are in assessing patient outcomes following shoulder surgery. He is an author of a book used for teaching and training of surgeons in training and has also authored book chapters in orthopaedics textbooks.

Dr Warren Davis Consultant Musculoskeletal Radiologist, Ipswich Hospital Dr Davis participated in the University College Hospital training scheme. He completed a Musculoskeletal Imaging Fellowship at the Royal London Hospital and was appointed Consultant Musculoskeletal and General Radiologist at Ipswich Hospital in January 2012.

Dr Richard Goodwin Consultant Radiologist, Norfolk and Norwich Hospital Richard Goodwin is a Consultant Radiologist with a full time musculoskeletal practice encompassing orthopaedic, rheumatological and elite sports imaging.

Mr Max Horwitz Consultant Surgeon, Chelsea and Westminster Hospital Mr Horwitz was educated and trained in South Africa and London and was appointed Consultant Hand Surgeon in the Hand Unit at Chelsea and Westminster Hospital in 2012. Prior to this he a was a Locum Consultant at the Major Trauma Centre at St Mary’s Hospital, London.

Mr Horwitz’s Orthopaedic and Trauma training was undertaken in London; he then traveled to a centre of global excellence in Sydney, Australia as the Pulvertaft Fellow of the British Society of Hand Surgery. On returning to London he undertook a fellowship in children’s hand conditions at the world renowned Great Ormond Street Hospital, London. He also undertook an AO fellowship in Trauma in Salzburg, Austria. During these fellowships he received training in advanced techniques including, the management of complex hand and upper limb trauma, wrist and hand arthritis as well as the treatment of congenital hand deformity, complex nerve injuries and microsurgery.

He has been awarded the BSSH postgraduate diploma in hand surgery and is a full member of the British Society for Surgery of the Hand and the British Orthopaedic Association. He has published many book chapters and scientific papers related to hand surgery.

He is married and has 2 boys and a dog. When not working he enjoys keeping fit, hiking and amateur photography, supporting Saracens, England and South Africa rugby teams and sunny holidays with his family.

His website can be found at : www.thehanddoctor.co.uk Mr Horwitz specialises in Children and Adults: Children • Common paediatric hand and wrist trauma • Congenital hand surgery • The treatment of hands in people with cerebral palsy, brain and spinal cord

injury Adults • Hand and upper limb trauma including: fractures and tendon injury • Arthritis of the hand and wrist including ganglion management • Sports injuries • Tendon injury and dysfunction (Triggering and De Quervains) • Nerve surgery (including carpal tunnel syndrome) • Dupuytrens surgery and injection Dr Monica Khanna Consultant Radiologist, Imperial College NHS Trust Dr Monica Khanna is a Consultant Radiologist at Imperial College Healthcare NHS Trust. She has been trained at the RNOH, Stanmore, and in Toronto and is a dedicated full time Musculoskeletal Radiologist. She has co-authored two books and contributed to the MSK literature. She has presented at a number of national and international meetings on various aspects of MSK imaging and teaches on dedicated MSK imaging courses.

Mr Addie Majed Upper Limb Orthopaedic Fellow, Royal National Orthopaedic Hospital Mr Majed trained at the Royal National Orthopaedic Hospital and is currently undertaking a post-CCT Fellowship with the Shoulder and Elbow Service. Whilst he enjoys all aspects of orthopaedic and trauma surgery, his main interest is shoulder and elbow surgery. Clinical assessment is an integral aspect of surgical practice but the confirmation of suspected diagnosis can only be made with appropriate and accurate imaging modalities. This virtually always commences with plain radiographs, which can provide an immense amount of invaluable information and are essential in planning clinical management.

Dr Adam Mitchell Consultant Radiologist, Chelsea and Westminster Hospital Radiological interests: Musculoskeletal and General Radiologist specialising in musculoskeletal imaging with a particular expertise in imaging sports injury.

Radiologist to several premiership London football and rugby union clubs.

Radiologist to sportsmen/women from across the UK. Provided radiological imaging services for a number of atheletes at Olympics in Beijing Provided radiology services for England Rugby and Cricket teams.

Gamesmaker Doctor at the 2012 London Olympics

Society memberships: Fellow of the Royal College of Radiologists.

Fellow of the Royal College of Surgeons.

Invited member of Radiology Visiting Club.

British Society of Musculoskeletal Radiologists.

European Society of Skeletal Radiology.

Lectures and teaching: Lecturer and teacher on regional, national and international courses in radiology, sports and exercise medicine, rheumatology and orthopaedics.

Publications: Author Grays Anatomy for Students 1st 2nd edns.

Author Grays Anatomy for Students Multiple language translations.

Author Grays Anatomy for Students Flashcards.

Author Dorlands/Grays pocket Atlas.

Author Grays Atlas of Anatomy for Students.

Editor of multiple books including Applied Radiological Anatomy, applied Radiological Anatomy for Medical Students.

Multiple chapters in medical textbooks.

Published over 50 peer-reviewed papers.

Multiple abstracts -national and international radiological meetings.

Management: Vice Chair Radiology Hammersmith Hospitals Trust Audit Committee (20002005).

Chairman New Devices and Procedures Committee (Hammersmith and Imperial NHS Trust) 2005-2009.

Lead Radiologist for Musculoskeletal Imaging Hammersmith/CXH 2000-2009.

Joint Head Graduate Entry Anatomy Imperial College 2007-2009.

Dr Ian Pressney Consultant Radiologist, Royal National Orthopaedic Hospital Dr Pressney is due to take up a musculoskeletal consultant post at the Royal National Orthopaedic Hospital in October, having thoroughly enjoyed his post CCT fellowship at RNOH. His pre-CCT MSK experience was gained at University Hospital Southampton. One of the main reasons he enjoys MSK imaging is because it utilizes multiple complimentary imaging modalities from the plain film to more complex MRI scans. Having said this, he is always amazed at how the original plain radiograph, even following cross-sectional imaging, often eloquently demonstrates the underlying pathology.

Gajan Rajeswaren Consultant Radiologist, Chelsea and Westminster Hospital Gajan Rajeswaran is a Consultant Radiologist with a Subspecialist Interest in Musculoskeletal Imaging at Chelsea and Westminster Hospital. He completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea and Westminster Hospital. He has completed two post-CCT fellowships in Musculoskeletal Imaging at Chelsea & Westminster Hospital and the Royal National Orthopaedic Hospital, Stanmore and worked as a Locum Consultant at Imperial College Healthcare NHS Trust and North West London Hospitals NHS Trust. He has several peer reviewed radiological publications and

has authored a chapter in a textbook. He lectures regularly at national and international conferences and is actively involved in medical education having completed a Postgraduate Certificate in Medical Education. He organizes and teaches on several courses.

Peter Reilly Consultant Surgeon, Imperial College Employment: Consultant shoulder and elbow surgeon Imperial NHS trust.

Honorary Senior Lecturer Imperial College London.

Training: Higher surgical training North West Thames.

Fellowship Nuffield Department of Orthopaedic surgery, Oxford.

MS Thesis on Rotator Cuff Tears Imperial College.

Memberships: British Orthopaedic Association.

British Elbow and Shoulder Society.

European Shoulder and Elbow Society.

Prizes and Awards: Robert Jones Medal and British Orthopaedic Association Prize 2002.

British Elbow and Shoulder Society European Travelling Fellow 2006.

Runner up Didier Patte Prize (European Shoulder and Elbow society) 2003.

Best presentation British Elbow and Shoulder Society 2000.

Relevant Research: More than 25 peer review papers.

Over fifty national / international presentations.

Book chapters related to shoulder surgery.

Dr Ben Roberton Consultant Musculoskeletal and Interventional Radiologist, Chelsea and Westminster Hospital NHS Trust Dr Roberton undertook undergraduate training at the University of Edinburgh and postgraduate medical training across London, before higher training in radiology at Chelsea and Westminster Hospital. His later experience included a musculoskeletal imaging fellowship, with an emphasis on sports imaging and musculoskeletal ultrasound and a prestigious interventional radiology fellowship in Vancouver, Canada, gaining experience in advanced interventional techniques with an emphasis on oncologic and musculoskeletal intervention, before returning to Chelsea and Westminster Hospital as a consultant radiologist. He has published and presented internationally on a range of topics including foot and ankle imaging, hand imaging and intervention, bone and solid organ thermal ablation and radioembolization.

Abstracts Shoulder joint replacement and complications Dr Ian Pressney and Mr Addie Majed Aims • To provide a comprehensive history of the shoulder joint replacement including current surgical trends.

• To further outline the radiographic positioning to obtain optimal plain radiographs of the shoulder.

• To describe the normal post-operative radiographic appearances including the indications and contraindications for each individual joint replacement.

A more focused interrogation of the potential post-operative complications and their incidences in each replacement encountered by both surgeon and radiologist will be addressed. An outline of the management strategies for these complications will be covered in short detail.

Learning objectives • Assess pre-operative shoulder radiographs with an appreciation of how they were obtained by the radiographer.

• Understand the clinical indications for different types of shoulder joint replacement.

• Confidently recognise and interpret normal post-operative joint replacement x-rays.

• Identify post-operative complications for each type of joint replacement.

Shoulder trauma - what the surgeon needs to know Dr Monica Khanna and Dr Peter Reilly Orthopaedic surgeons and radiologists think differently, both specialties should recognize this and work together.

This presentation will look at how orthopaedic surgeons think, identify areas where radiologists to add value to the management of trauma patients and reaffirm the value of radiographs.

Radiographic findings in the shoulder, elbow and wrist with age and normal variants Dr Subhasis Basu and Mr Rupen Dattani

The wrist Dr Richard Goodwin and Mr Adrian Chojnowski Common but easily underestimated wrist trauma will be highlighted with particular regard to the importance of carpal stability in the context of trauma.

The hand and fingers Mr Max Horwitz and Dr Ben Roberton • • • • •

Hand and finger views Rheumatology made simple Bone lesions Trauma of the hand and fingers Congenital abnormalities of the hands and fingers

Case review Dr Warren Davis This session will consist of a series of real life cases taken from a district general hospital setting. It will be an interactive session that will involve the presentation of plain film studies of the upper limb, and subsequent complex imaging. The aim of the case discussion is to re-enforce the teaching points learned though the day, with emphasis on commonly missed findings on plain film and radiographic measurements used.

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