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Imaging of the Painful Lower Limb Stump¹

¹ From the Department of Radiology, Centre Alexis Vautrin, Ave de Bourgogne, 54511 Vandoeuvre-les-Nancy, France (P.H., J.S.); and the Departments of Physical Medicine and Rehabilitation (N.M., J.P.) and Radiology Guilloz (F.W., A.B.), Hôpital Central University of Nancy 1, France. Recipient of a Cum Laude award for a scientific exhibit at the 1999 RSNA scientific assembly. Received January 31, 2000; revision requested March 9 and received May 1; accepted May 4. Address correspondence to P.H. (e-mail: p.henrot@nancy.fnclcc.fr).

Several postoperative complications associated with pain may develop in the stump of an amputated lower limb. Clinical findings are often nonspecific; however, radiologic evaluation, especially with magnetic resonance (MR) imaging, is useful in the early diagnosis of these complications, thereby helping minimize physical disability with its psychologic and socioeconomic implications. Conventional radiography can demonstrate evidence of osseous origins of pain (eg, aggressive bone edge, heterotopic ossification, osteomyelitis) and should be the first imaging study performed after clinical examination. Videofluoroscopy can help evaluate improper prosthetic fit by demonstrating abnormal residual limb motion, piston action, rolling of soft tissues, and abnormal angle between the limb axis and the prosthesis during gait. Ultrasonography can demonstrate inflammatory changes in the stump as well as soft-tissue fluid collections. However, MR imaging is the modality of choice when clinical and other imaging findings are indeterminate. Because of its high spatial and contrast resolution, MR imaging can demonstrate subtle inflammatory changes, fluid collections, cancers, neuromas, and subtle traumatic bone lesions. Knowledge of various surgical and rehabilitation techniques is required for accurate diagnosis of complications associated with stump pain. Correct diagnosis allows choice of the most appropriate therapy, which may involve treating the stump, remodeling the prosthesis, or both.

Index Terms: Extremities, amputation, 45.452 • Extremities, prostheses, 45.454 • Stents and prostheses • Trauma, 45.452

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