The suggestion of a meniscal tear produces a pavlovian response in the orthopaedic surgeon. However, meniscal signal anomalies and associated changes become common with age in symptom free knees. T he issue for the IME requested to assess workers with painful knees is to determine if the MRI changes represent a painful injury and if the treatment planned (usually arthroscopy) may, in fact, be harmful. MRI signal changes are assessed on the likelihood they predict for unstable meniscal tears. Some patterns of meniscal tears are benign. Associated changes such as baker's cyst and ligament thickening are also common but are poor predictors of symptomatic tears. Preclinical osteoarthritis has a high incidence of associated meniscal change and arthroscopic menisectomy may accelerate osteoarthritis progression. Clinical tests have variable specificity and sensitivity but in combination with an understanding of the patterns of MRI signal can be combined to predict which meniscal tears would benefit from arthroscopic surgery, which injuries would do as well with non-operative treatment and which patterns predict deterioration after surgery. As the views of the IME are often contrary to the surgeon, a comprehensive bibliography is provided for any who need to argue their case. As the topic is information and image dense, a CD ROM will be distributed

Giant synovial cyst is commonly seen in association with rheumatoid arthritis. The Baker’s cyst around the knee is the commonest example but it has also been described at the elbow and hip. The possibility of a synovial cyst around the hip is unfamiliar to most clinicians including those who regularly deal with inguinal swellings and those specialising in musculoskeletal conditions. This is often overlooked as a cause of symptoms in inguinal area and lower limb. We present a report on two patients in whom abnormal pulsatile masses in the groin caused diagnostic difficulty. Patients were initially admitted under vascular surgeons with a clinical diagnosis of aneurysm. Ultrasound examination was useful in excluding aneurysm. Detailed clinical examination revealed painful restricted hip movements and an X–ray showed evidence of arthritis in hip joint. CT Scan confirmed it to be a synovial cyst. Computed Arthrotomogram or Arthrography showed communication of the cyst with hip joint. Synovial cysts and iliopsoas bursa enlargement may be more common than previously reported. They may present as a pulsatile mass due to close proximity to femoral vessels and should be considered as a differential diagnosis in patients with unusual inguinal swelling