2a > MSK > Flashcards

MSK Flashcards

(636 cards)

Study These Flashcards
1
Q

Describe pivot shift injury

A

ACL
Segond fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What injuries are found in a clip injury?

A
  • valgus stress to a flexed knee
  • contusion pattern: lateral femoral condyle and lateral tibial plateau +/- medial femoral condyle from MCL avulsive stress
  • associated with MCL injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a Segond fracture

A

Avulsion fracture of the knee that involves lateral aspect of tibial plateau

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What injuries are found in dashboard injury

A
  • anterior force to tibia in a flexed knee
  • contusion pattern: anterior tibia +/- posterior patella
  • associated with PCL tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What injuries are associated with lateral patellar dislocation?

A
  • twisting injury to flexed knee
  • contusion pattern: anterolateral lateral femoral condyle and inferomedial patella
  • associated with medial patellar retinaculum +/- medial patellofemoral ligament injury +/- medial patellotibial ligament injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is O’Donoghue unhappy triad

A
  • ACL tear
  • MCL injury
  • medial meniscus tear (lateral compartment bone bruise)

Lateral force applied to knee while foot fixed on ground (abduction external rotation mechanism, or pivot shift)
*** lateral meniscus injury more common than injury to medial meniscus given lateral compartment is compressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What injuries are associated with hyperextension injury of the knee?

A
  • direct force to anterior tibia with foot planted
  • contusion pattern: “kissing contusions” of anterior tibial plateau and anterior femoral condyle
  • associated with ACL, PCL, meniscal injuries and in severe cases knee dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Champagne glass pelvis

A

Achondroplasia - the iliac blades are flattened, giving rise to a pelvic inlet that resembles a champagne glass. The acetabular angles are flattened (horizontal) and the sacrosciatic notch is small.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Posterior vertebral body scalloping

A
  • intramural spinal mass/intradural spinal cyst
  • dural ectasia (NF1, Marfans, Ehler Danlos, osteogenesis imperfecta, Loeys-Dietz syndrome)
  • congenital skeletal disorders (achondroplasia due to small spinal canal, mucopolysaccharidoses, Hurler syndrome, Morquio syndrome)
  • acromegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Posterior vertebral body scalloping pneumonic

A

S: spinal cord tumour (e.g. astrocytoma, ependymoma, schwannoma)
A: achondroplasia, acromegaly
L: Loeys-Dietz syndrome (and other connective tissue disorders)
M: Marfan’s syndrome, mucopolysaccharidoses
O: osteogenesis imperfecta
N: neurofibromatosis type 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anterior vertebral body scalloping

A

Retroperitoneal lymphadenopathy, including (but not limited to):
- chronic leukaemia
- lymphoma
- tuberculosis
Abdominal aortic aneurysm
Down syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is segond fracture associated with

A

75% associated with ACL tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lateral capsule sign

A

On frontal XR - segond fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SONK

A

Spontaneous Osteonecrosis of the Knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SONK is

A

an insufficiency fracture.

Favours medial femoral condyle.
Usually unilateral.
Associated with meniscal injury/post meniscal surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Navicular stress fracture

A

High risk AVN. Runners on hard surfaces.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

March fracture

A

Metatarsal stress fracture. Military recruits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Calcaneal stress fracture

A

Most fractured tarsal bone.

usually intraarticular. The stress fracture will be seen with # line perpendicular to trabecular lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Blood flow to scaphoid is

A

Retrograde (distal to proximal) via the dorsal carpal branch of the radial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First sign of scaphoid AVN

A

Sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most common # site of scaphoid

A

Waist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Scaphoid prox pole is at risk for

A

AVN / MalUnion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Trans-scaphoid perilunate dislocation have high association with

A

(60%) with a scaphoid fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Scapholunate ligament disruption has gap of

A

> 3mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
The SL ligament is composed of 3 parts -
Volar Dorsal Middle
26
Humback deformity scaphoid
waist fracture - angulation of proximal and distal fragments Can progress to collapse and non union Assoc with DISI
27
The most important band of the SL ligament
Dorsal band for carpal stability
28
The most important band of the luna triquetral ligament
Volar band
29
Prieser disease
Atraumatic AVN of the scaphoid
30
Scaphoid AVN on MRI
T1 dark
31
SLAC occurs with
Injury (or degeneration via CPPD) to the SL ligament
32
SNAC occurs with
Scaphoid fracture
33
The first joint to develop degenerative changes in SNAC
Radioscaphoid joint
34
Terry Thomas sign
Gap between scaphoid and lunate on plain film - scapholunate ligament tear
35
Most important band for carpal stability in S-L tear
Dorsal band
36
DISI stands for
Dorsal Intercalated Segmental Instability
37
VISI stands for
Volar Intercalated Segmental Instability
38
DISI and SL angle -
Widening of the SL angle Dorsiflexion of the lunate Angle >60
39
VISI and SL angle
Narrowing of the SL angle Volar flexion of the lunate and scaphoid Angle <30
40
S-L dissociation is wider than
3mm
41
Best view for S-L dissociation
Clenched fist
42
Chronic SL dissociation can result in
SLAC wrist
43
Perilunate dislocation
Lunate is ok, carpal bones (capitate) around it move.
44
Mid carpal dislocation associated with
Triquetral fracture
45
Perilunate dislocation associated with
60% assoc with scaphoid fractures
46
Mid carpal dislocation
Both lunate and capitate lose radial alignment Triquetro-lunate interosseous ligament disruption
47
Lunate dislocation
Lunate moves, others stay "most severe" carpal dislocation
48
Why does lunate dislocation happen
Dorsal radiolunate ligament injury
49
Which synovial spaces normally communicate
Pisiform recess Radiocarpal joint
50
TFCC 5 components
1. Triangular Fibrocartilage (articular disc) 2. Volar and dorsal radioulnar ligaments 3. Meniscus homologue 4. UCL 5. Tendon sheath of the ECU
51
Positive variance associated with
Ulnar impaction syndrome
52
Negative variance associated with
AVN of the lunate (Keinbock)
53
inijjjkmlj÷>dd
Love Phoebe
54
Ulnar impaction Syndrome
Seen with positive ulnar variance The distal ulna smashes into the lunate, degenerating it ( cystic change/geodes etc ...) and tears up the TFCC.
55
Kienbocks:
AVN of the lunate, seen in people in their 20s-40s. Associated with negative ulnar variance.
56
Kienbocks on plain film
Sclerotic on plain film
57
Kienbocks on MRI
Low signal on T1
58
Colles fracture
Dorsal angulation - distal radial metaphysis fracture Assoc ulnar styloid fracture
59
Smith fracture
Volar angulation - distal radial metaphysis fracture Assoc ulnar styloid fracture
60
Barton fracture
Radial rim fracture Dorsal or volar, volar more common Radial - carpal dislocation is "hallmark" High rate redislocation/malunion
61
There are .... wrist compartments
6 extensor compartments
62
First compartment of wrist
APL EPB
63
Compartment affected in de Quervains
First
64
Third compartment of wrist
EPL, courses beside Listers Tubercle
65
Sixth compartment of the wrist
Extensor carpi ulnaris
66
Early tenosynovitis in rheumatoid arthritis occurs in which compartment
6th
67
The carpal tunnel lies deep to
Palmaris longus
68
The carpal tunnel is defined by 4 bony prominences
Pisiform Scaphoid tubercle Hook of hamate Trapezium tubercle
69
The fibrous sheath wrapping around the carpal tunnel is the
Transverse carpal ligament
70
The tunnel contains 10 things -
4 flexor D profundus (FDP) 4 flexor D superficials (FDS) 1 flexor pollicis longus (FPL) 1 median nerve
71
Does NOT go through the tunnel
Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Flexor pollicis brevis
72
Carpal tunnel syndrome
Median nerve distribution (thumb to radial aspect of the 4th digit) Can have thenar muscle atrophy
73
Carpal tunnel syndrome is associated with
repetitive trauma assoc with dialysis, pregnancy, DM, HYPOthyroidism
74
US/MRI carpal tunnel findings
Increased signal in the median nerve Nerve may be swollen or look flattened Bowing of the flexor retinaculum
75
Guyons canal syndrome
Entrapment of the ulnar nerve Classically caused by handle bars Fracture of hook of hamate can also do it
76
Guyons canal is formed by
the pisiform and hamate
77
Sub sheath tear/dislocation
Traumatic dislocation to the extensor carpi ulnaris (ECU - compartment 6) out of its normal groove at the level of the distal ulna. Trivia - the direction of dislocation is medial.
78
Sub sheath tear/dislocation implies rupture of
rupture of the overlying sheath.
79
Tenosynovitis on MRI/US
Inflammation of the tendon with increased fluid seen around the tendon
80
Diffuse tenosynovitis
TB or nonTB mycobacterial Rheumatoid arthritis
81
Focal tenosynovitis
Penetrating infection (can be focal or diffuse) Overuse
82
TB or non TB tenosynovitis
Hand and wrist most common tendons affected Spares the muscles Usually occurs in patients who are immunocompromised
83
TB tenosynovitis classic finding
Discrete filling defects in the fluid filled sheaths - RICE BODIES
84
Rheumatoid arthritis
Multiple flexor tendons OR Isolated extensor carpi ulnaris if early (ECU = compartment 6)
85
Penetrating infection tenosynovitis
Of any flexor tendon is a surgical emergency - can spread rapidly to common flexors of the wrist Increased pressure in the sheath can cause necrosis of the tendons
86
Usual direct infection in a fisherman or sushi chef causing tenosynovitis
Mycobacterium marinum
87
Overuse tenosynovitis
Classic location like 1st extensor compartment for De Quervians
88
De Quervians tenosynovitis
Repetitive activity/overuse 1st extensor compartment - extensor pollicus brevis (EPB) and abductor pollicis longus (APL)
89
Finkelstein test
Pain on passive ulnar deviation
90
De Quervians tenosynovitis US
Increased fluid within the first extensor tendon compartment
91
De Quervians tenosynovitis MRI
Increased T2 signal in the tendon sheath
92
Intersection Syndrome:
A repetitive use issue (classically seen in rowers) Occurs when the first extensor tendons "intersects" the second extensor compartment tendons. Result = extensor carpi radials brevis and longus tenosynovitis Occurs 5cm proximal to listers tubercle
93
Bennett fracture
Fracture at base of 1st MC - simple
94
Rolando fracture
Fracture at base of 1st MC - comminuted
95
What causes dorsolateral dislocation in Bennetts fracture
The pull of the of the abductor pollicus longus (APL) tendon
96
Gamekeepers (skiers) thumb
Avulsion fracture at the base of the proximal first phalanx assoc with ulnar collateral ligament disruption
97
Stener Lesion
The adductor tendon aponeurosis gets caught in the torn edges of the UCL The displaced ligament wont heal correctly and needs surgery
98
Radiographic stress views for Gamekeepers thumbs
DONT DO IT - can cause Stener lesion
99
Trigger finger
Overuse/repetitive trauma causes scarring in the flexor tendon sheath. "stenosing tenosynovitis."
100
Sail sign -
Elevation of the fat pads from a joint effusion. Supposedly a sign of occult fracture. 1) the posterior fat pad is more specific (posterior is positive) 2) the posterior fat pad can appear falsely elevated (false positive) if the lateral isn't a true 90 degree flexed lateral. "Posterior Positive, Posterior Position Dependent"
101
Capitellum fractures are associated with
posterior dislocation
102
Monteggia fracture
prox ulna ant dislocation of the radial head
103
Galeazzi #
radial shaft # ant dislocation of ulna at the DRUJ
104
Essex-Lopresti
radial head and ant dislocation of the distal radial ulnar joint Unstable # with rupture of the IO membrane
105
Cubital tunnel causes
- repetitive valgus stress - accessory anconeus
106
Lateral Epicondylitis
- tennis players - Extensor Tendon Injury (classically extensor carpi radialis brevis) - Radial Collateral Ligament Complex - Tears due to varus stress
107
Medial Epicondylitis
- (less common than lateral) - seen in golfers - Common flexor tendon and ulnar nerve may enlarge from chronic injury
108
Partial Ulnar Collateral Ligament Tear:
throwers (people who valgus overload) Ulnar collateral ligament (attaches on the medial coronoid) injury The ligament has three bundles, and the anterior bundle is by far the most important.
109
T-sign
UCL partial tear on MRI - contrast extends medial to the tubercle
110
Epitrochlear Lymphadenopathy
Cat-scratch disease.
111
Dialysis Elbow:
This is the result of olecranon bursitis from constant pressure on the area, related to positioning of the arm during treatment.
112
Partial biceps tear associated with
Bicipitoradial bursitis
113
Biceps tear typically occurs
In the shoulder with tendon avulsing off the labrum or the level of the bicipital groove
114
Popeye deformity
Rolled up muscle in antecubital fossa because of full or partial biceps tear
115
Injury to the bicep is associated with
median nerve symptoms
116
Tricep rupture
Uncommon - when does, think of salter harris II fractures of the olecranon
117
Associated fractures with elbow dislocation
- radial head - coronoid process
118
Posterior Rotary Instability
1. Starts in posterior lateral corner with tearing of the lateral UCL. 2. Partial dislocation - coronoid perched on trochlea 3. Dislocation - coronoid posterior to humerus with a UCL tear
119
Ant inf shoulder dislocation
- most common 90% - Hill Sachs/Bankart - GT avulsion fracture in 10-15%
120
Hill Sachs
Posterior lateral humeral head impaction fracture Best seen on internal rotation view
121
Bankart
Anterior inferior labrum
122
Posterior dislocation shoulder
- uncommon - prob from seizure of electrocution - rim sign - trough sign - light bulb sign
123
Rim sign
No overlap glenoid and humeral head
124
Trough sign
Reverse Hill Sachs, impaction fracture on anterior humerus
125
Light bulb sign
Arm may be locked in internal rotation on all views
126
Inferior dislocation shoulder
- uncommon - arm sticking straight over the head - 60% get neurologic injury (usually axillary room)
127
luxatio erecta humeri
Inferior dislocation shoulder
128
Reverse Bankart
Posterior glenoid rim fracture (posterior dislocation)
129
Neer classification
How many parts a broken proximal humeral fracture is in
130
Cuff intact and glenoid intact - which shoulder surgery?
Resurfacing or hemi
131
Cuff intact and glenoid deficient - which shoulder surgery?
TSA
132
Cuff deficient and glenoid intact - which shoulder surgery?
Hemi or reverse
133
Cuff deficient and glenoid deficient - which shoulder surgery?
Reverse total shoulder
134
Total Shoulder Most Common Complication =
Loosening of the Glenoid Component
135
Total Shoulder Complication - "Anterior Escape" -
This describes anterior migration of the humeral head after subscapularis failure.
136
Reverse Total Shoulder Does NOT require an intact rotator cuff because
patient rely heavily on the deltoid.
137
Reverse Shoulder Complication -
Posterior Acromion Fracture - from excessive deltoid tugging.
138
Coracoacromial arch is made up of
The coracoid process, acromion, and coracoacromial ligament.
139
Impingement/rotator cuff tear types
External - impingement of the rotator cuff overlying the bursal surfaces adjacent to the arch - primary or secondary Internal - impingement of the rotator cuff on the undersurface along the glenoid labrum and humeral head - posterior superior or anterior superior
140
Primary external causes of rotator cuff impingement
Abnormal coracoacromial arch - hooked acromion (B3) - subacromial osteophyte formation or thickening of the coracoacromial ligament - subcoracoid impingement: impingement of the subscapularis between the coracoid process and lesser tuberosity (congenital or post traumatic)
141
Secondary External Causes of rotator cuff impingement
Normal Coracoacromial Arch - "Multidirectional Glenohumeral Instability" - resulting in micro subluxation of the humeral head in the glenoid, resulting in repeated micro-trauma. Joint laxity patients, labrum often normal
142
Posterior Superior Causes of rotator cuff impingement:
Occurs when the posterior superior rotator cuff (junction of the supra and infraspinatus tendons) comes into contact with the posterior superior glenoid. Best seen in the ABER position, where these tendons get pinched between the labrum and greater tuberosity. Seen in athletes who make overhead movements (throwers, tennis, swimming).
143
Anterior Superior Causes of rotator cuff impingement:
Occurs when the arm is in horizontal adduction and internal rotation. In this position, the undersurface of the biceps and subscapularis tendon may impinge against the anterior superior glenoid rim.
144
Primary external subacromial impingement damages
Supraspinatus
145
Primary external subcoracoid impingement damages
Subscapularis
146
Posterior superior impingement damages
Infraspinatus (and post supra) Posterior superior labrum torn Cystic change in GT
147
Anterior superior impingement damages
Sub scapular damage Anterior superior labrum torn
148
Rotator cuff tears are either
Bursal sided (top part) Articular sided (the undersurface) Articular surface x3 more common
149
Most common of the rotator cuff muscles to tear
Supraspinatus
150
Where do most tears of the supraspinatus occur
the critical zone (relatively avascular site) - 1-2cm from the tendon footprint
151
Which is the least common rotator cuff muscle to tear
The teres minor
152
How do you know it's a full thickness tear?
You will have high T2 signal in the expected location of the tendon. On T1 you will have Gad in the bursa.
153
Adhesive Capsulitis
"Frozen Shoulder" An inflammatory condition characterized by a global decrease in motion.
154
The fibrous rotator cuff interval
Junction between anterior fibers of the Supraspinatus and superior fibers of the subscapularis
155
Adhesive Capsulitis commonly affects
The rotator cuff interval
156
"Decreased Glenohumeral Volume" - with injection
Adhesive capsulitis
157
"Increased Glenohumeral Volume" - with injection
Multi-directional instability
158
"Thickened Inferior and Posterior Capsule"
Adhesive capsulitis
159
"Enhancement ol the Rotator Cuff Interval" - Post gad
Adhesive capsulitis
160
When the SLAP extends into the biceps anchor (type 4), the surgical management changes from a debridement to
a debridement + biceps tenodesis.
161
The mechanism of a SLAP tear
is usually an over-head movement ( classic = swimmer)
162
SLAP tears in people over 40 usually have associated
Rotator Cuff Tears
163
SLAP tears are usually NOT associated with
Instability
164
SLAP:
Labral tears that favor the superior margin and track anterior to posterior. Tear involves the labrum at the insertion of the long head of the biceps - injury to this tendon is associated and part of the grading system (type 4)
165
SLAP Mimic -
The Sublabral Recess. Normal variant, incomplete attachment of the labrum at 12 o'clock.
166
LAP vs sublabral recess appearance
SLAP extends lat, SR follows contour of glenoid SLAP ratty margin, SR smooth margin
167
Labral Tear Mimics (x2)-
The Sublabral Foramen The Buford Complex
168
The Sublabral Foramen
unattached (but present) portion of the labrum - located at the anterior-superior labrum (1 o'clock to 3 o'clock).
169
The Buford Complex
1% of population - absent anterior/superior labrum (1 o'clock to 3 o'clock) - thickened middle glenohumeral ligament.
170
GLAD =
Glenolabral Articular Disruption.
171
Glenolabral Articular Disruption is ...
the mildest anterior dislocation related injury. Superficial ant inf labral tear with assoc articular cartilage damage - "impaction injury with cartilage defect" Common in sports. No instability.
172
Perthes with re to ant dislocation injury
Detachment of anteroinerior labrum (3-6 o'clock) with medially stripped but intact periosteum
173
ALPSA with re to ant dislocation injury
Medially displaced labroligamentous complex with absence of the labrum on the glenoid rim. Intact periosteum. It scars down to glenoid.
174
ALPSA =
Anterior Labral Periosteal Sleeve Avulsion.
175
True Bankart is
Can be cartilaginous or osseous. The periosteum is disrupted. There is often an associated Hill Sach's fracture.
176
Reverse Osseous Bankart:
A fracture of the posterior inferior rim of the glenoid.
177
POLPSA:
(post version of ALPSA) The posterior labrum and the posterior scapular periosteum (still intact) are stripped from the glenoid resulting in a recess that communicates with the joint space.
178
"Bennett Lesion"
An extra-articular curvilinear calcification - associated with posterior labral tears (maybe the POLPSA). It's related to injury of the posterior band of the inferior glenohumeral ligament.
179
"Kim's Lesion"
An incompletely avulsed / flattened / mashed posteriorinferior labrum. A key (testable) point is the glenoid cartilage and posterior labrum relationship is preserved.
180
HAGL =
Humeral avulsion glenohumeral ligament
181
HAGL is
an avulsion of the inferior glenohumeral ligament, and is most often the result of an anterior shoulder dislocation
182
Subluxation of the Biceps Tendon:
Subscapularis Tear = Medial Dislocation of the Long Head of the Biceps Tendon.
183
The subscapularis attaches to
the lesser tuberosity.
184
The subscapularis sends a few fibers across the bicipital groove to
the greater tuberosity , which is called the "transverse ligament".
185
A cyst at the level of the suprascapular notch will affect
the supraspinatus and the infraspinatus.
186
A cyst at the level of the spinoglenoid notch
will only affect the infraspinatus.
187
Quadrilateral Space Syndrome:
Compression of the Axillary Nerve in the Quadrilateral Space (usually from fibrotic bands). Atrophy of the teres minor.
188
The borders of the quadrilateral space:
Teres Minor Above, Teres Major Below, Humeral neck lateral, and Triceps medial.
189
Parsonage-Turner Syndrome:
This is an idiopathic involvement of the brachial plexus. Think about this when you see muscles affected by pathology in two or more nerve distributions (suprascapular and axillary etc .. ).
190
Medial femoral shaft fracture
Stress fracture location
191
Lateral femoral shaft fracture
Bisphosphonate related fracture location
192
Is iliopectineal line anterior or posterior
Anterior
193
Is ilioischial line anterior or posterior
Posterior
194
The corona mortis is
The anastomosis of the inferior epigastric and obturator vessels - sometimes rides on the superior pubic ramus.
195
The femoral head gets its vascular supply from
The circumflex femorals
196
Which muscle avulses from the iliac crest?
Abdominal muscles
197
Which muscle avulses from the ASIS?
Sartorius Tensor Fascia Lata
198
Which muscle avulses from the AIIS?
Rectus femoris
199
Which muscle avulses from the greater trochanter?
Gluteal muscles
200
Which muscle avulses from the symphysis?
ADDuctor group
201
Which muscle avulses from the ischial tuberosity?
Hamstrings
202
Which muscle avulses from the lesser trochanter?
Iliopsoas
203
What is T2 fat sat
Fatty tissue appears dark instead of bright, greatly enhances visibility of fluid (oedema, inflammation, cysts)
204
Snapping hip syndrome can be due to
External type (most common) - ITB snapping over GT Intraarticular type - hip degen/loose bodies Internal - iliopsoas over iliopectineal eminence or femoral head
205
ITB syndrome
Repetitive stress syndrome in runners Fluid on both sides of the ITB, extending post and lat
206
Which hip labral tear is most common
Anterior superior tear
207
What is associated with a hip labral tear/indicates one may be present
Paralabral cysts
208
A fluid signal "mass" ant to femur (adj to psoas tendon) at level of the ischial tuberosity
Iliopsoas bursitis
209
Iliopsoas bursa
largest bursa of the body Communicates with the joint in 15% Seen ant to hip The tendon runs ant to the labrum on axial and can mimic a tear
210
CAM type FAI
An osseous bump along the femoral head-neck junction More common in men
211
Pincer type FAI
Deformity of the acetabulum More common in middle aged women
212
Cross over sign
Acetabulum is malformed so post lip crosses over the anterior lip - pincer type FAI (coccyx needs to be centered at the symphysis pubis to evaluate this ie no rotation to image)
213
Coxa Profunda
Acetabulum projects medial to the ilioischial line
214
Acetabular Protrusion
Femur projects medial to the ilioischial line
215
Classic FAI Association:
- Os Acetabuli ( 40%) - Labral Tears - Early Arthritis
216
Os Acetabuli
This is an unfused secondary ossification center. Normal in kids (should fuse by adulthood). Assoc with FAI and Labral Tears
217
Wear vs creep in THR
Thinning in area of weight bearing = creep Abnormal wear on superior lateral aspect = pathologic
218
Particle disease in THA
Most common in non cemented hips 1-5 yrs post op XR - smooth end-steal scalloping (distinguishes from infection) Aseptic (normal ESR and CRP) No 2ry bone response - no sclerosis Can be seen around screw holes (particles are transmitted around screws) Wear - particle disease - osteolysis
219
Honda sign
Sacral insufficiency fracture
220
Sacral insufficiency fracture
Common cause - postmenopausal osteoporosis Also - renal failure, pts with RA, pelvic radiation, mechanical changes post hip arthroplasty, extended steroid use
221
Segond fracture
Fracture of the lateral tibial plateau (common distractor is medial tibia). Associated with ACL tear (75%), and occurs with internal rotation.
222
Reverse Segond Fracture:
Fracture of the medial tibial plateau. Associated with a PCL tear, and occurs with external rotation. Associated medial meniscus injury.
223
Arcuate Sign:
Avulsion of proximal fibula (insertion of arcuate ligament complex). 90% are associated with cruciate ligament injury (usually PCL)
224
Deep lntercondylar Notch Sign:
Depression of the lateral femoral condyle (terminal sulcus) that occurs secondary to an impaction injury. Associated with ACL tears.
225
ACL:
Composed of two bundles (anteromedial & posterolateral). The tibial attachment is thicker than the femoral attachment. Both the ACL and PCL are intra-articular and extrasynovial.
226
PCL:
The strongest ligament in the knee (posterior dislocation of knee can result in dissection of popliteal artery).
227
MCL:
The MCL fibers are laced into the joint capsule at the level of the joint, with connection to the medial meniscus. Unlike the ACL and PCL, the MCL is an extra-articular structure.
228
Conjoint Tendon:
Formed by the biceps femoris tendon and the LCL.
229
ACL & PCL
Extrasynovial and intraarticular. The synovium folds around the ligaments.
230
The IT band inserts on
Gerdys tubercle
231
ACL Tear:
Associated with Segond Fracture (lateral tibial plateau) and tibial spine avulsion Classic Kissing Contusion Pattern: lat femoral condyle and post lat tibial plateau Anterior drawer sign
232
O'donoghue's Unhappy Triad:
ACL Tear, MCL Tear, Medial Meniscal Tear
233
ACL Mucoid Degeneration:
Mimic of acute or chronic partial tear of the ACL but no secondary signs of injury. It predisposes to ACL ganglion cysts, and they are usually seen together. The T2/STIR buzzword is "celery stalk" because of the striated look. The T1 buzzword is "drumstick" because it looks like a drum stick.
234
"Drumstick / Celery Stick"
Mucoid Degeneration of the ACL
235
T1 drumstick appearance of ACL
ACL Mucoid Degeneration
236
T2/STIR striated look of ACL
ACL Mucoid Degeneration
237
Cyclops Lesion -
Scar Associated with Ventral Graft Low signal mass-like scar in Hoffa's fat pad. It limits extension. >16/52 post op
238
Radial tear meniscus:
- Cuts the circular hoop fibres that hold the meniscus together - Can lead to extrusion, early OA etc .
239
Flap tear (Parrot Beak) meniscus:
Radial tear that changes direction into the longitudinal direction
240
Longitudinal tear meniscus:
- Can be vertical or horizontal (or mixed oblique patterns) - Defined by a long extension in the axial direction - Vertical types can flip (bucket- handle)
241
Horizontal cleavage tear meniscus:
- Pure cleavage tears extend to the apex - Associated with meniscal cysts - Most common in posterior horn of the medial meniscus
242
Radial Tears: There are 3 classic Signs
1. Truncated triangle 2. Cleft - most reliable 3. "ghost" or absent triangle
243
Discoid Meniscus:
Normal variant of the lateral meniscus that is prone to tear. Disc shaped. Paeds patient with meniscal tear.
244
Bucket Handle Tear:
A torn meniscus (usually medial - 80%) vertical longitudinal sub-type, that flips medially to lie anterior to the PCL. "double PCL"
245
Too many bowties (meniscus MRI)
Discoid meniscus
246
Not enough bowties (meniscus MRI)
Bucket handle tear
247
"Meniscus extending into the inter femoral notch"
Discoid meniscus
248
Double PCL sign
Bucket handle tear. Can only occur in the setting of an intact ACL
249
Bakers Cyst:
Occurs between the semimembranosus and the MEDIAL head of the gastroc
250
Meniscal Cysts:
Most often seen near the lateral meniscus and are often associated with horizontal cleavage tears.
251
Meniscocapsular Separation:
The deepest layer of the MCL complex (capsular ligament) is relatively weak and is the first to tear. This deep tearing may result in the separation of the meniscus and the MCL. (1) it happens more with proximal MCL tears (2) this is a serious injury - requires immobilization or surgery.
252
Meniscal Ossicle:
Focal ossification of the posterior horn of the medial meniscus - can be secondary to trauma or developmental. Often associated with radial root tears.
253
Meniscofemoral Ligaments:
There are 2 (Wrisberg, Humphry) which can be mimics of meniscal tears. Wrisberg is in the back ( "humping Humphry"). You could also remember that "H" comes before "W" in the alphabet.
254
Meniscal Flounce:
Uncommon finding of a "ruffled" appearance of the meniscus that mimics a tear. It's NOT associated with an increased incidence of tear - but can look like one
255
Patella Dislocation:
Usually lateral because of the shape of the patella and femur. Contusion pattern - Classic - lat femoral condyle and medial aspect patella Associated tear of the MPFL (medial patellar femoral ligament) Associated with "Trochlear Dysplasia" - the trochlea is too flat.
256
Patella alta
If the patella tendon tears you will get unopposed quadriceps tendon pull resulting in a high patella (Alta).
257
Patella baja
If the quadricep tendon tears you will get unopposed pull from the patellar tendon resulting in a low patella (Baja).
258
"Bilateral patellar rupture"
is a buzzword for chronic steroids.
259
Jumpers knee MRI
High T2 signal and thickening of the inferior patella
260
Fat impingement syndrome MRI
High T2 signal in Hoffa's fat inferior to the patella
261
Prepatellar bursitis MRI
Fluid superficial to the patella
262
Tibial plateau fracture occurs due to
Axial loading (falling and landing on a straight leg)
263
Tibial plateau fracture
- lateral plateau more common than medial - if you see medial, usually with lateral - Schatzker classification - type 2 most common
264
Pilon Fracture is aka
Tibial plafond fracture
265
Pilon fracture occurs due to
Axial load, with talus being driven into tibial plafond
266
Pilon fracture
Comminution and articular impaction of tibial plafond. About 75% of the time have fracture of the distal fibula.
267
Tibial Shaft Fracture
- most common long bone fracture - the tibia is one of the slowest healing bones in the body (about 10 weeks)
268
Tillaux Fractures:
Salter-Harris 3, through the anterolateral aspect of the distal tibial epiphysis.
269
The distal tibial growth plate closes from
medial to lateral (medial first).
270
Lateral physis of distal tibia typically closes around what age?
12-15
271
Triplane Fracture:
Salter-Harris 4, with a vertical component through the epiphysis, horizontal component through the physis, and oblique through the metaphysis.
272
Maisonneuve Fracture:
Unstable fracture involving the medial tibial malleolus and/or disruption of the distal tibiofibular syndesmosis, with a fracture of the proximal fibular shaft
273
Casanova Fracture
Fracture calcaneus
274
Next step with bilateral calcaneal fractures?
look at the spine (Tl2-L2) for a compression or burst fracture
275
Danger of lateral calcanea fractures
Peroneal tendons can become entrapped
276
Most common tarsal bone fracture
Calcaneal fracture (60%)
277
Are fractures of the calcaneus extra-articular or intra-articular
Either - depends on subtalar joint involvement Intra-articular fractures will have a fracture line through the "critical angle of Gissane"
278
Bohler's Angle
20-40 The line drawn between the anterior and posterior borders of the calcaneus on a lateral view. "More Flat" (Less than 20) = Calcaneal Fracture
279
Critical Angle of Gissane
95-105 Line drawn along the superior surfaces of the anterior process and the posterior face of the calcaneus to meet at the calcaneal sulcus (on lateral) "More Flat" (More than 130) = Depression of the Posterior Facet
280
Stress Fracture of the 5th Metatarsal:
High risk fracture (hard to heal).
281
Jones Fracture:
Fracture at the base of the fifth metatarsal, 1.5cm distal to the tuberosity.
282
Avulsion Fracture of the 5th Metatarsal:
This is more common than a Jones fracture. The classic history is a dancer.
283
Painful Os Peroneus Syndrome (POPS)
Os Peroneus (accessory ossicle) is within the Peroneus LONGUS Stress reaction and pain can progress to tendon disruption= POPS
284
MR Key Findings in POPS:
Oedema in the os peroneus just before the peroneus longus tendon enters the cuboid tunnel
285
Lisfranc injury
Most common dislocation of the foot - the joint is the articulation of the tarsals and metatarsal bases. Can't exclude it on a non-weight bearing film Associated fractures are most common at the base of the 2nd MT - "Fleck Sign"
286
The Lisfranc ligament connects
the medial cuneiform to the 2nd metatarsal base on the plantar aspect.
287
"Fleck Sign"
Lisfranc injury associated fracture, most common at the base of the 2nd MT (between 1st and 2nd MT) - assoc avulsion of the LF ligament
288
Mechanism of lisfranc injury
Extreme plantar flexion and axial load
289
Achilles tendon is made up of the fused tendons of
the gastrocnemius and the soleus
290
The weakest ligament in the foot
The anterior talofibular ligament is the weakest and most frequently injured
291
Acute flat foot
Posterior tibial tendon injury
292
Posterior Tibial Tendon Injury / Dysfunction results in
a progressive flat foot deformity, as the PTT is the primary stabilizer of the longitudinal arch.
293
Acute Posterior Tibial Tendon Injury tear location
the tear is most common at the insertion into the navicular bone.
294
Chronic Posterior Tibial Tendon Injury tear location
the tear is most common behind the medial malleolus (this is where the most friction is).
295
Sinus Tarsi
The space between the lateral talus and calcaneus.
296
Sinus Tarsi Syndrome:
caused by hemorrhage or inflammation of the synovial recess with or without tears of the associated ligaments (talocalcaneal ligaments, inferior extensor retinaculum).
297
MRI finding sinus tarsi syndrome
Obliteration of fat (loss normal T1 bright fat) in the sinus tarsi space, and replacement with scar.
298
MRI plantar fasciitis
a thickened fascia (> 4mm) , most often the central band with increased T2 signal, most significant near its insertion at the heel.
299
Plantar fasciitis is
inflammation of the fascia secondary to either repetitive trauma, abnormal mechanics or arthritis
300
Split Peroneus Brevis:
Longitudinal splits in the peroneus in people with inversion injuries. The history is usually "chronic ankle pain".
301
Split Peroneus Brevis imaging
The tendon will be C shaped or boomerang shaped with central thinning and partial envelopment of the peroneus longus. Alternatively, there may be 3 instead of 2 tendons. The tear occurs at the lateral malleolus. There is a strong (80%) association with lateral ligament injury.
302
Anterolateral Impingement Syndrome:
Injury to the anterior talofibular ligaments and tibiofibular ligaments (usually from an inversion injury) can cause lateral instability, and chronic synovial inflammation. You can eventually produce a "mass" of hypertrophic synovial tissue in the lateral gutter.
303
Anterolateral Impingement Syndrome on MRI
A "meniscoid mass" in the lateral gutter of the ankle, which is a balled up scar (T1 and T2 dark).
304
Tarsal tunnel syndrome is
Pain in the distribution of the posterior tibial nerve (first 3 toes) from compression as it passes through the tarsal tunnel (behind the medial malleolus).
305
Morton's Neuroma:
Soft tissue mass (tear drop shaped) shown between the 3rd and 4th metatarsal heads (third intermetatarsal space) Its not actually a neuroma, its a scan (perineurial fibrosis)
306
"Mulder's Sign"
- is a physical exam (a sonographic sign) where you squeeze the patients foot and reproduce the pain ( or see the scar pop out under ultrasound).
307
Morton's Neuroma on MRI
Its a scar so dark on T1 and T2 Tear drop shaped and projects downwards
308
Haglund's Syndrome / Deformity
* Retro-Achilles bursitis, / * Retrocalcaneal bursitis, * Thickening of the distal Achilles tendon (insertional portion) * Calcaneal Bony Prominence "prominent posterior superior os calcis"
309
Os Trigonum Syndrome is
The os trigonometry presses on the FHL during extreme ankle flexion (like ballet)
310
Os Trigonum Syndrome findings
( 1) "Stenosing" tenosynovitis / collection of fluid around the FHL, and (2) edema within the Os Trigonum and across the synchondrosis between the Os and the Posterior Talus.
311
Achilles Tendon Injury:
Acute rupture is usually obvious with a fluid filled gap. The tear is usually 4 cm above the calcancal insertion
312
Plantaris Rupture
"Achilles tendon ruptured but can still plantar flex" This tendon is absent in 10% of the population.
313
Plantaris rupture on MRI
Focal fluid collection between the soleus and the medial head of the gastrocnemius. There is an association with ACL tears.
314
Avulsions of the Calcaneal Tuberosity:
Aunt Minnie with the back of the bone totally ripped off via the Achilles. The classic association is diabetes.
315
Osteopenia is
Increased lucency of bones.
316
Osteomalacia is
This is a soft bone from excessive uncalcified osteoid.
317
Osteomalacia appearance
- Ill-defined trabeculae, - Ill-defined corticomedullary junction, - bowing, - "Loosers Zones."
318
Looser Zones:
Wide lucent bands that transverse bone at right angles to the cortex. Classic locations - femoral neck, pubic rami Typically sclerosis surrounding the lucency, symmetry. Type of insufficiency fracture.
319
Osteoporosis:
Low bone density
320
Imaging findings of osteoporosis
a thin sharp cortex, prominent trabecular bars, lucent metaphyseal bands, and spotty lucencies.
321
T score =
Density relative to young adult T score defines osteopenia vs osteoporosis
322
T score ranges
T score> -1.0 = Normal, -1.0 to -2.5 = Osteopenia, <-2.5 Osteoporosis
323
Transient osteoporosis of the hip:
The joint space should remain normal. It's self limiting and resolves in a few months.
324
Transient osteoporosis on imaging (Plain film, MRI, bone scan)
Plain film shows osteopenia, MRI shows Edema, Bone scan shows increased uptake focally.
325
Regional migratory osteoporosis
an idiopathic disorder which has a very classic history of pain in a joint, which gets better and then shows up in another joint. It's associated with osteoporosis - which is also self-limiting. It's more common in men.
326
Transient osteoporosis vs AVN on XR
Transient Osteoporosis is super lucent AVN will have patchy areas of sclerosis.
327
Osteoporotic Compression Fracture MRI:
On MR you want to see a "band like" fracture line - which is typically T1 dark (T2 is more variable). The non-deformed portions of the vertebral body should have normal signal.
328
Neoplastic Compression Fracture:
Most vertebral mets don't result in compression fracture until nearly the entire vertebral body is replaced with tumour.
329
Osteochondritis Dissecans (OCD) classic location
The femoral condyle (most common site in the knee), patella, talus, and capitellum.
330
OCD is
Osteochondritis Dissecans Aseptic separation of an osteochondral fragment which can lead to gradual fragmentation of the articular surface and secondary OA. Commonly 2ry to trauma
331
Kohlers
Tarsal Navicular Boys 4-6. Treatment is not surgical.
332
Freibergs
Second Metatarsal Head Adolescent Girls - can lead to secondary OA
333
Sever's
Calcaneal Apophysis Some say this is a normal "growing pain"
334
Panner's
Capitellum Kid 5-10 "Thrower"; does not have loose bodies.
335
Perthes (LCP)
Femoral Head White kid; 4-8.
336
Kienbock
Carpal Lunate Associated with negative ulnar variance. Seen in adults 20-40.
337
Scheuermann
Thoracic Spine Causes kyphosis. 3 adjacent levels with wedging, plus a thoracic kyphosis of > 40 degrees (normal 20-40)
338
Osgood-Schlatter Disease (OSD)
Tibial Tubercle Adolescents (10-15) who jump and kick. Need Fragmentation + Soft Tissue Swelling.
339
Sinding-Larsen-J ohansson (SLJ)
Inferior Patella Adolescents (10-15) who jump.
340
Osteomyelitis in Spine =
IV Drug User
341
Osteomyelitis in Spine with Kyphosis (Gibbus Deformity) =
TB
342
Unilateral SI joint =
IV Drug User
343
Psoas Muscle Abscess =
TB
344
Chronic Osteomyelitis:
This is defined as osteomyelitis lasting longer than 6 weeks.
345
Draining sinus ducts are a risk factor for
Squamous cell ca
346
Most specific sign of active chronic osteomyelitis is
the presence of a sequestrum (Piece of necrotic bone surround by granulation tissue)
347
Acute Bacterial Osteomyelitis Age < 1 month =
Multi-centric involvement, often with joint involvement. Bone scan often negative (75%) at this age
348
Acute Bacterial Osteomyelitis Age < 18 months =
Spread to epiphysis through blood
349
Acute Bacterial Osteomyelitis Age 2-16 years =
Trans-physeal vessels are closed (primary focus is metaphysis).
350
MRI findings of osteomyelitis:
Low signal in the bone marrow on T1 imaging adjacent to an ulcer or cellulitis is diagnostic. (specific) STIR - High Signal in Bone Adjacent to Ulcer (more sensitive sign)
351
The Ghost Sign:
A bone that becomes a ghost (poor definition of margins) on T1 imaging, but then re-appears (more morphologically distinct) on T2, or after giving IV contrast, is more likely to have osteomyelitis.
352
Discitis in adults
the source is usually from a recent surgery, procedure, or systemic infection.
353
Discitis in children (under 5)
it's usually from hematogenous spread.
354
The most common bug causing disci tis
Staph A is the most common bug, and always think about an IV drug user.
355
Epidural Abscess
This is an infected collection between the dura and periosteum. Classic Appearance: - T1 Dark, T2 Bright, - Peripheral Enhancement, & - Restricted Diffusion. Classic Scenario: - HIV patient - Bad Diabetic.
356
"Gibbus Deformity"
This is a focal kyphosis seen in "Pott Disease" , among many other thing
357
Pott Disease
TB of the spine The vertebral body is involved with sparing of the disc space until late in the disease "Large paraspinal abscess" "Calcified Psoas Abscess" "Gibbus Deformity"
358
Brucellosis
- unpasteurized milk from an Amish person - can also have disc space preservation so looks like TB discitis
359
"Tuberculosis Dactylitis" (Spina Ventosa)
Typically seen in kids with involvement of the short tubular bones of the hands and feet. Often a smoldering infection without periosteal reaction. Classic look is a diaphyseal expansile lesion with soft tissue swelling.
360
"Rice Bodies"
These are sloughed, infarcted synovium seen with end stage RA, and TB infection of joints.
361
Septic arthritis in IV drug users
SI joints and sternoclavicular joint
362
Nec fash bug
polymicrobial (the second form is Group A Strep).
363
The best sign that a bone lesion is aggressive?
Wide zone of transition
364
Codman triangle
If the tumor grows rapidly enough it can break through the cortex and destroy the newly formed bone capsule / lamellated bone resulting in triangle structure
364
Bone destruction that occurs in a uniform geographic pattern is more suggestive of
a benign slow growing lesion.
365
A moth-eaten (cluster of small lytic holes) or permeative (ill-defined tiny oval or streak like lucencies) suggests
rapid infiltrative tumour growth - as seen in myeloma, lymphoma, and Ewings sarcoma.
366
Intramedullary osteosarcoma
More common, and higher grade than the surface subtypes (periosteal, and parosteal). Primary subtypes typically occur in young patients (10-20). The most common location is the femur (40%), and proximal tibia (15%).
367
"Sunburst"
- periosteal reaction that is aggressive and looks like a sunburst
368
Lamellated ( onion skin reaction)
- multi layers of parallel periosteum, looks like an onion's skin.
369
Osteosarcoma met to the lung is a "classic" cause of
occult pneumothorax
370
"Reverse Zoning Phenomenon"
- more dense mature matrix in the center, less peripherally (opposite of myositis ossificans).
371
Parosteal Osteosarcoma:
Generally low grade, BIG BULKY parosteal bone formation. Early adult/middle aged. The buzzword is "string sign" - which refers to a radiolucent line separating the bulky tumor from the cortex.
372
Classic location Parosteal Osteosarcoma:
- posterior distal femur (because of this location it can mimic a cortical desmoid "tug lesion" early on). - The lesion is metaphyseal 90% of the time.
373
"string sign"
a radiolucent line separating the bulky tumor from the cortex (parosteal osteosarcoma)
374
Periosteal Osteosarcoma:
Worse prognosis than parosteal but better than conventional osteosarcoma. Ages 15-25. Tends to occur in the diaphyseal regions, classic medial distal femur.
375
Marrow extension parosteal vs periostea
Marrow extension 50% in parosteal Usually no marrow extension in periosteal
376
Telangiectatic Osteosarcoma:
About 15% have a narrow zone of transition. Cystic on plain film. Fluid-Fluid levels on MRI is classic. They are High on T1 (from methemoglobin). Can be differentiated from ABC or GCT (maybe) by tumour nodularity and enhancement.
377
Chondrosarcoma:
Usually seen in older adults (M>F). Likes flat bones, limb girdles, proximal tubular bones. Can be central (intramedullary) or peripheral (at the end of an osteochondroma). Most are low grade.
378
RF for chondrosarcoma
Pagets, and anything cartilaginous ( osteochondromas, Maffucci etc ... )
379
Arcs and rings
Chondrosarcoma (its the chondroid matrix)
380
Factors Favoring Chondrosarcoma:
Pain Cortical Destruction Scalloping of> 2/3 of the cortex >5cm in Size "Changing Matrix"
381
Ewings:
Permeative lesion in the diaphysis of a child = Ewings Likes to met bone to bone (skip lesions)
382
Ewings is different to osteosarcoma because -
Does NOT form osteoid from tumour cells, but can mimic osteosarcoma because of its marked sclerosis (sclerosis occurs in the bone only, not in the soft tissue - which is NOT the case in osteosarcoma).
383
Chordoma:
Usually seen in adults (30-60), usually slightly younger in the clivus and slightly older in the sacrum. MIDLINE!!! Very T2 bright.
384
Chordoma location
most common sacrum, second most common clivus, third most common vertebral body
385
Most common primary malignancy of the spine.
Chordoma
386
Most common primary malignancy of the sacrum.
Chordoma
387
When involving the spine, most common location for Chordoma
C2
388
Epiphseal lesions
AIGC ABC Infection Giannt cell Chondroblastoma **ABC usually metaphysical but after the growth plate closes it can extend into the epiphysis
389
Epiphyseal Equivalents: (bones that will have the same lesions as the epiphysis)
Carpals, Patella, Greater Trochanter, Calcaneus
390
malignant epiphyseal tumour
Clear Cell Chondrosarcorna.
391
Metaphyseal lesions
The fastest growing area of a bone, with the best blood supply. This excellent blood supply results in an increased predilection for Mets and Infection. Most of the cystic bone lesions can occur in the metaphysis.
392
Fibrous Dysplasia is
a skeletal developmental anomaly of osteoblasts - failure of normal maturation and differentiation which results in replacement of the normal medullary space.
393
Fibrous Dysplasia locations
Likes the ribs and long bones. If it occurs in the pelvis, it also hits the ipsilateral femur (Shepherd Crook deformity). If it's multiple it likes the skull and face (Lion-like faces).
394
Shepherd Crook
-Coxa Varus Angulation -Classic for FD (but can be seen in Paget and OI)
395
Fibrous Dysplasia age
can occur at any age - but the multiple lesion variety "polyostotic" - tends to occur earlier (<10).
396
Adamantinoma:
A tibial lesion that resembles fibrous dysplasia (mixed lytic and sclerotic). It is potentially malignant.
397
Jaffe-Campanacci Syndrome:
Syndrome of multiple NOFs, cafe-au-lait spots, mental retardation, hypogonadism, and cardiac malformations.
398
Nonossifying Fibroma (NOF):
- very common - seen in children (rare in children not yet walking) - will spontaneously regress (sclerotic then disappear) - like to occur around the knee - eccentric with a thin sclerotic border, >3cm
399
NOF vs FCD
NOFs are the larger version (> 3cm) of a fibrous cortical defect (FCD) (<2cm)
400
Enchondroma:
A tumour of the medullary cavity composed of hyaline cartilage. Progressively more common with age - peaking around 10-30 years old. It looks different depending on which body part it is in.
401
Enchondroma in fingers or toes appearance
Lytic
402
Enchondroma in Humerus or Femur appearance
Arcs and Rings
403
the most common cystic lesion in the hands and feet
enchondroma
404
Differentiating Enchondroma vs Low Grade Chondrosarcoma
Enchondroma - not painful, 1-2cm, arcs and rings, pattern does NOT change LG Chondrosarcoma - painful, >4-5cm, arcs and rings pattern changes - moves around grows etc
405
Multiple enchondromas?
Syndrome - Ollier vs Maffucci
406
OIiier Disease
Multiple Enchondromas (3 or more) Slight increase risk in Chondrosarcoma
407
Maffucci Syndrome
Multiple Enchondromas (Maffucci has More) Hemangiomas (bunch lucent centered calcifications) Increase risk in Chondrosarcoma (probably more than Oilier)
408
Eosinophilic Granuloma (EG):
Peak age 5-10 Solitary (usually) or multiple Appearance is highly variable and can be lytic or blastic, with or without a sclerotic border, and with or without a periosteal response. Can even have an osseous sequestrum.
409
3 classic appearances of EG
(1) Vertebra plana in a kid (2) Skull with lucent "beveled edge" lesions (also in a kid). (3) "Floating Tooth" with lytic lesion in alveolar ridge
410
Classic DDx for Vertebra Plana
MELT - Mets/Myeloma - EG - Lymphoma - Trauma/TB
411
Classic DDx for Osseous Sequestrum:
- OM - Lymphoma - Fibrosarcoma - EG * osteoid osteoma can mimic a ssequestrum
412
Giant Cell Tumor (GCT) key criteria:
- Physis MUST be closed - Non Sclerotic Border - Abuts the articular surface
413
GCT location
Most common in the knee - abutting the articular surface
414
415
GCT facts
- Most common at age 20-30 - physis must be closed - There is an association with ABCs (they can tum into them) - They are "quasi-malignant" - 5% have lung mets - Fluid levels on MRI
416
Osteoid Osteoma
"Adolescent" - 10-25 ish. Oval lytic lesion ("lucent nidus") surrounded by dense sclerotic cortical bone ("periosteal reaction").
417
"Pain at night, relieved by aspirin. "
Osteoid Osteoma
418
Osteoid Osteoma classic locations
(1) Meta/diaphysis of long bones (femoral neck= most common) (2) Posterior elements of the spine (lumbar > cervical > thoracic). Technically fingers are more common than spine
419
Osteoid Osteoma association
Painful Scoliosis Growth Deformity: Increased length and girth of long bones Synovitis: Can be seen if intra-articular, joint effusions Arthritis: Can occur from primary synovitis, or secondarily from altered joint mechanics.
420
Osteoid osteoma MRI
"large amount of oedema for the size of the lesion." Adjacent soft tissue oedema is also common
421
Osteoid osteoma nuclear bone scan
"Double Density Sign" - very intense central activity at nidus, surrounded by less intensity of reactive bone. A common distractor is a stress fracture. Stress fractures are linear. Osteoid osteoma should be round.
422
Osteoid osteoma in the spine
- most common in the posterior elements of the lumbar spine - associated painful scoliosis with the convexity pointed away from the lesion
423
Osteoid osteoma treatment
Percutaneous radiofrequency ablation (as long as it's not within 1 cm of a nerve or other vital structure - typically avoided in hands, spine, and pregnant patients)
424
Osteoblastoma
An osteoid osteoma that is larger than 2 cm Patients < 30 years old Most likely to show this in the posterior elements. It also occurs in the long bones (35%) and when it does it is usually diaphyseal (75%)
425
Chondroblastoma:
kids (90% age 5-25) - thin sclerotic rim, - extension across the physeal plate (25-50%) - periostitis (30%). femur > humerus > tibia They tend to reoccur after resection (like 30% of the time).
426
Chondroblastoma on MRI
May show bone marrow edema, and soft tissue oedema on MRI (MRI can mislead you into thinking it's a bad thing). This is one of the only bone lesions that is often NOT T2 bright.
427
When you have a chondroblastoma in the hip, it tends to favour
the greater trochanter (more than the femoral epiphysis)
428
Chondromyxoid Fibroma is (age and location)
the least common benign lesion of cartilage patients <30 classic location in the proximal metaphyseal region of the tibia
429
Chondromyxoid Fibroma appearance
An osteolytic, elongated in shape, eccentrically located, metaphyseal lesion, with cortical expansion and a "bite" like configuration.
430
An avulsion of the lesser trochanter of the hip without significant clinical hx
Pathologic fracture
431
Ddx intertrochanteric region of hip lesions
Lipoma, Solitary Bone Cyst, and Monostotic Fibrous Dysplasia.
432
Aneurysmal Bone Cyst (ABC):
Aneurysmal lesions of bone with thin walled, blood-filled spaces (fluid-fluid level on MRI). Patients < 30. They may develop following trauma Tibia> Vert> Femur> Humerus
433
Classic DDx for Lucent Lesion in Posterior Elements:
Osteoblastoma ABC TB
434
Bone lesion with fluid fluid level on MRI
ABC
435
Up to 40% of secondary ABC's are associated with
GCT
436
Solitary (Unicameral) Bone Cyst:
Patient < 30 Most common in tubular bone (90-95%) ALWAYS located centrally Fallen fragment sign
437
Fallen fragment sign
Bone fragment in the dependent portion of a lucent bone lesion Pathognomonic of solitary bone cyst
438
Brown Tumor (Hyperparathyroidism):
- Represents localized accumulations of giant cells and fibrous tissue - lytic or sclerotic lesions with other findings of hyperparathyroidism (subperiosteal bone resorption).
439
Solitary bone cyst MRI
T1 dark T2 bright Fallen fragment sign
440
lntraosseous Lipoma in calcaneus
(a) fat density on CT or MRI, or (b) a central fragment - stuck within the middle of the fat (calcification/fat necrosis)
441
Geode:
Older Patient + Subtalar degenerative change/ Obvious Arthritis
442
Metastatic Disease bone lesion:
- differential for any patient over 40 with a lytic lesion.
443
Prostate Met vs Bone Island?
Get a Bone Scan - Bone Island should be mild ( or not active) - Prostate Met should be HOT
444
Classic blastic lesions: (mets to bone)
Prostate, Carcinoid, Medulloblastoma
445
Classic Lytic Lesions: (mets to bone)
Renal and Thyroid
446
Multiple Myeloma (MM):
Plasma cell proliferation increases surrounding osteolytic activity Older patient (40's-80's) Plasmacytomas can precede clinical or hematologic evidence of myeloma by 3 years
447
Multiple myeloma appearance
They usually have discrete margins, and can be solitary or multiple. Vertebral body destruction with sparing of the posterior elements is classic.
448
Multiple myeloma imaging -
Bone Scan is often negative, skeletal survey is better, and MRI is the most sensitive.
449
Plasmacytoma
Usually < 40 yo A discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue (extramedullary subtype) The lesions look like a geographic lytic area, sometimes with expansile remodeling.
450
"Mini Brain Appearance"
- Plasmacytoma in vertebral body
451
POEMS:
"Myeloma with Sclerotic Mets." It's a rare medical syndrome with plasma cell proliferation (typically myeloma) , neuropathy, and organomegaly.
452
Long Lesion in a Long Bone =
FD
453
Ground glass bone lesion =
FD
454
Lytic bone lesion with a hazy matrix =
FD
455
Chondroid Matrix in the Proximal Humerus or Distal Femur =
Enchondroma
455
Lucent Lesion in the Finger or Toe =
Enchondroma
456
Epiphyseal Tibial Lesion in a Teenager =
Chondroblastoma
457
Epiphyseal Equivalent Lesion =
Chondroblastoma or Giant Cell Tumor **technically GCTs grow into the Epiphysis
458
Lucent Lesion in the Greater Trochanter =
Chondroblastoma
459
Lucent Lesion with a Fracture (Fallen Fragment) in the Humerus =
Solitary bone cyst
459
Calcaneal Lesion with Central Calcification =
Lipoma
460
Lucent Lesion in the Skull =
EG
461
Vertebra Plana in a Kid =
EG
462
Vertebra Plana in an Adult =
Mets
463
Sequestrum / Nidus in the Tibia/ Femur =
Osteoid osteoma
464
"Painful Scoliosis"
Osteoid Osteoma
465
Calcified Lesion in the Posterior Element of the C-Spine =
Osteoblastoma
466
Multiple Sclerotic Lesions =
Mets
467
Multiple Sclerotic Lesions Centered Around a Joint =
Osteopoikolosis
468
Multiple Lucent Lesions ( older than 40) =
Mets, Myeloma, Metastatic Non-Hodgkin Lymphoma
469
Nidus < 2.0 cm =
Osteoid Osteoma
470
Nidus > 2.0 cm =
Osteoblastoma
471
Well-defined lytic lesion in the cortex of a long bone with a sclerotic rim < 3 cm =
Fibrous cortical defect
472
Well-defined lytic lesion in the cortex of a long bone with a sclerotic rim > 3 cm =
Nonossifying fibroma
473
Chondral lesion in a long bone 1-2 cm =
Probably an Enchondroma
474
Chondral lesion in a long bone > 4-5 cm =
Increased risk of low-grade chondrosarcoma
475
Liposclerosing Myxofibroma:
Very characteristic location - at the intertrochanteric region of the femur. Looks like a geographic lytic lesion with a sclerotic margin. Despite nonaggressive appearance, 10% undergo malignant degeneration so they need to be followed.
476
Osteochondroma:
- most common benign tumour ("exostosis") - can be radiation induced - very small risk malignant transformation (if a cartilage cap >1.5cm then concerning) - they point away from the joint - the bone marrow flows freely into the lesion
477
Multiple Hereditary Exostosis:
AD condition with multiple osteochondromas. They have an increased risk of malignant transformation.
478
Trevor Disease is aka
Dysplasia Epiphysealis Hemimelica - DEH
479
Trevor disease =
- characterized by the development of osteochondromas developing at the epiphysis which result in significant joint deformity - most common in ankle and knee - they point INTO the joint - affect young children, Tx with surgical excision
480
Supracondylar Spur (Avian Spur):
Aunt Minnie, and normal variant. - points towards the joint - characteristic location distal humerus - not originated from the epiphysis can compress the median nerve if the Ligament of Struthers smashes it.
481
Periosteal Chondroma (Juxta-Cortical Chondroma):
It's a rare entity, of cartilaginous origin. "Saucerization" of the adjacent cortex with sclerotic periosteal reaction can be seen. Lesion in the finger of a kid.
482
Osteofibrous Dysplasia:
- benign lesion found exclusively in the tibia or fibula in children (10 and under) - looks like NOF but is centred in the anterior tibia, associated tibial bowing
483
Distal Femoral Metaphyseal Irregularity (Cortical Desmoid):
- a lucency seen along the back of the posteriomedial aspect of the distal femoral metaphysis. - often bilateral - "scoop like defect" with an "irregular but intact cortex" Incidental finding, dont touch, dont biopsy, dont MRI.
484
Calcium Hydroxyapatite:
Calcium hydroxyapatite deposition disease = calcific tendinitis. Most common location is shoulder Specifically, the supraspinatus tendon, usually at its insertion near the greater tuberosity Also found in the longus colli (ant to atlas to T3)
485
Causes of Calcium hydroxyapatite deposition disease
primary (idiopathic) secondary - chronic renal disease, collagen-vascular disease, tumoral calcinosis hypervitaminosis D.
486
Osteopoikilosis:
Lots of bone islands Usually in epiphyses Tend to be joint centred Osteopoikilosis patients tend to be keloid formers.
487
Osteopathia Striata:
Linear, parallel, and longitudinal lines in metaphysis of long bones.
488
Engelmann's Disease is aka
progressive diaphyseal dysplasia or PDD.
489
Engelmann's Disease:
fusiform bony enlargement with sclerosis of the long bones. - Its Bilateral and Symmetric - It likes the long bones - usually shown in the tibia - Its, hot on bone scan - It can involve the skull - and can cause optic nerve compression
490
Thalassemia:
- "hair-on-end" skulls - expansion of the facial bones (obliterates sinuses) - "rodent faces," - expanded ribs "jail-bars" It is frequently associated with extramedullary hematopoiesis.
491
AVN of the hip causes
Perthes in kids sickle cell Gaucher's steroid use traumatic with femoral neck fractures
492
Plain Film Stages of Osteonecrosis
- Zero = Normal - One = Normal x-ray, oedema on MR - Two = Mixed Lytic / Sclerotic - Three = Crescent Sign, Articular Collapse, Joint Space Preserved - Four = Secondary Osteoarthritis
493
Double Line Sign:
AVN of the hip Best seen on T2; inner bright line (granulation tissue), with outer dark line (sclerotic bone).
494
Rim Sign:
Best seen on T2. High T2 signal line sandwiched between 2 low signal lines. Represents fluid between sclerotic borders of an osteochondral fragment, and implies instability (stage III).
495
Crescent Sign:
Seen on XR (optimally frog leg) Refers to a subchondral lucency seen most frequently in the anterolateral aspect of the proximal femoral head. Indicated imminent collapse.
496
Paget Disease (Osteitis Deformans):
Affects 4% of people at 40, and 8% at 80 M>F Most people are asymptomatic The bones go through three phases which progress from lytic to mixed to sclerotic (1) Monostotic and (2) Polyostotic - with the poly subtype being much more common (80-90%).
497
"Wide Bones with Thick Trabecula"
Pagets disease
498
Blade of Grass Sign:
Lucent leading edge in a long bone Aka "flame". Often spares the final even in diffuse disease. Pagets
499
Osteoporosis Circumscripta:
Blade of Grass in the Skull Large areas of osteolysis in the frontal and occipital bones Pagets
500
Picture Frame Vertebra:
Cortex is thickened on all 4 margins (Rugger Jersey is only superior and inferior endplates) Pagets
501
Cotton Wool Bone:
Thick disorganized trabeculae Pagets (mixed phase)
502
Banana Fracture:
Insufficiency fracture of a bowed soft bone (femur or tibia). Pagets
503
Tam O 'Shanter Sign:
Thick Skull - with the frontal aspect "falling over the facial bones" Pagets
504
Saber Shin:
Bowing of the tibia Pagets
505
Ivory Vertebra:
This is a differential finding, including mets. Pagets tends to be expansile.
506
Classic look of Pagets
Expanded bone Coarse or thick trabecular pattern
507
Complications of Paget's
Deafness is the most common complication. Spinal stenosis from cortical thickening is very characteristic. Additional complications - cortical stress fracture, cranial nerves paresis, CHF (high output), secondary hyperparathyroidism (10%),
508
Most common tumour that Pagets will devolve to
Secondary development of osteosarcoma (1%) - which is often highly resistant to treatment. GCT can arise from Pagets also.
509
ALP in Pagets
Elevated up to x20 in the reparative phase
510
Pagets in the spine
(1) An enlarged "ivory vertebrae", (2) Picture frame vertebrae (sclerotic border) - with central lysis (mixed phase)
511
Renal Osteodystrophy in the spine
"Rugger Jersey Spine" - with sclerotic bands at the top and bottom of the vertebral body. Can also have paraspinal soft tissue calcifications
512
Osteopetrosis in the spine
Thick cortical bone, with diminished marrow. On plain film or CT it can look like a Rugger Jersey Spine or Sandwich vertebra. On MR - loss of the normal T1 bright marrow signal, so it will be T1 and T2 dark.
513
"H-Shaped Vertebra"
Sickle cell It results from microvascular endplate infarct. If dont say H shape, might say widened disc space If not sickle cell, then Gauchers
514
Lytic / Early Mixed Pagets MRI -
Heterogenous T2; Tl is isointense to muscle, with a "speckled appearance"
515
Late mixed Pagets MRI -
Maintained fatty high T1 and T2 signals
516
Sclerotic Pagets MRI
Low signal on T1 and T2
517
Nuclear med scan Pagets -
Whole bone involvement Hot on all three phases (often decreased or normal in sclerotic phase)
518
Physiologic tibial bowing is
smooth, lateral, and occurs from 18 months - 2 years.
519
Anterior tibial bowing with a fibular pseudoarthrosis
NF1 Anterior lateral - may be unilateral May have hypoplastic fibula
520
Tibial bowing with wide growth plates
Rickets
521
Posterior tibial bowing
Foot deformities
522
Lateral tibial bowing - bilateral symmetic
Physiological Self limiting between 18m and 2yrs
523
Lateral tibial bowing in a newborn
Hypophosphatasia "Rickets in a newborn"
524
Lateral tibial bowing
Rickets Fraying of the metaphyses and widening of the growth plates. Seen best in "fast growing bones" - knee, wrist
525
Tibial Vara - Often asymmetric
Blount Early walking, Fat, black kid. Proximal tibia posteromedial physeal growth disturbance resulting in deformity
526
Short tibias
Dwarfism
527
Malignant Fibrous Histiocytoma (MFH) is aka
Pleomorphic Undifferentiated Sarcoma "PUS."
528
Malignant Fibrous Histiocytoma (MFH)
- very common - old people - central location (proximal arms and legs)
529
Malignant Fibrous Histiocytoma (MFH) on MRI
Dark to intermediate on T2 (remember most soft tissue tumours are T2 bright). "fibrous" - makes me think scar (which is dark).
530
Malignant Fibrous Histiocytoma (MFH) associated with
spontaneous hemorrhage - they outgrow their blood supply.
531
Bone infarcts can turn into
MFH - "sarcomatous transformation of infarct"
532
Synovial Sarcoma:
Seen most commonly in the peripheral lower extremities of patients aged 20-40. Occur close to the joint (but not in the joint). Can cause pain, soft tissue calcifications and bone erosions highly suggestive. Slow growing and small. 90% translocation of X-18
533
Baker's Cyst
MUST be located between the medial head of the gastrocnemius and the semimembranosus.
534
"triple sign"
High, medium, and low signal all in the same mass on T2 Synovial sarcoma
535
"bowl of grapes"
A bunch of fluid -fluid levels in a mass (probably in the knee) Synovial sarcoma
536
Most common malignancy in teens/young adults of the foot, ankle, and lower extremity
Synovial sarcoma
537
"Ball-like tumour" in the extremity of a young adult
Synovial sarcoma
538
"Soft Tissue Tumour in the Foot" of a young adult
Synovial sarcoma
539
Lipoma
Signal Intensity parallels fat on all sequences Will Fat Sat Out No Sepations (or thin ones)
540
Atypical Lipoma/ Low Grade Liposarcoma
May have parts that are slightly darker (or brighter) than fat on T1. May incompletely fat sat Thick Chunky Septations
541
High Grade Liposarcoma
May not even have fat (for the exam it will have some otherwise you can't even tell for sure that it is a Liposarcoma) May incompletely fat sat (or not fat sat at all) Thick Nodular Complex Stuff Enhancing Components
542
The most common liposarcoma in patients < 20
Myxoid Liposarcoma Can be T2 Bright (expected), but T1 dark (confusing). Need Gad+
543
Mazabraud Syndrome
(1) Polyostotic Fibrous Dysplasia - which makes you ugly (2) Multiple Soft Tissue Myxomas
544
Haemangioma
- T2 bright (like most tumors) - Flow voids - Hemangiomas don't respect fascial boundaries - they will infiltrate into stuff (this is a somewhat unique feature). - Enhances Intensely - Duh - they are a vascular tumour - They can contain fat
545
Soft tissue phleboliths on plain film
Haemangioma
546
Myxoma
T2 bright (like every tumour), but tend to be lower signal than muscle on T 1 Think Mazabraud Syndrome
547
Osteosarcoma treatment
Chemo first (to kill micro mets) , followed by wide excision
548
Ewings treatment
Both Chemo and Radiation, followed by wide excision.
549
Chondrosarcoma treatment
Usually just wide excision (they are usually low grade, and main concern is local recurrence).
550
Giant Cell Tumour treatment
Because it extends to the articular surface usually requires arthroplasty.
551
Pigmented Villonodular Synovitis (PVNS)
An uncommon benign neoplastic process that may involve the synovium of the joint diffusely or focally. It can also affect the tendon sheath. Synovial Proliferation + Hemosiderin Deposition.
552
Giant Cell Tumour of the Tendon Sheath (PVNS of the tendon):
Typically found in the hand (palmar tendons). Can cause erosions on the underlying bone. Will be soft tissue density, and be T1 and T2 dark (contrasted to a glomus tumour which is T1 dark, T2 bright, and will enhance uniformly).
553
The most common joint affected in PVNS
The knee (65 - 80%)
554
PVNS on plain film
A joint effusion with or without marginal erosions Osseous erosions with preservation of the joint space and normal mineralization is typical.
555
PVNS on MRI
Blooming on gradient echo
556
PVNS treatment
Complete synovectomy, although recurrence rate is 20-50%.
557
Primary Synovial Chondromatosis:
A metaplastic / true neoplastic process (not inflammatory) that results in the formation of multiple cartilaginous nodules in the synovium of joints, tendon sheaths, and bursea. These nodules will eventually progress to loose bodies. It usually affects one joint - usually the knee (70%). Patient aged 40's or 50's.
558
Secondary Synovial Chondromatosis:
Secondary to degenerative change, and typically seen in an older patient. Extensive degenerative changes, and the fragments are usually fewer and larger when compared to the primary subtype.
559
Joint bodies in Primary Synovial Chondromatosis:
Usually multiple and uniform in size May demonstrate the ring and arc calcification characteristic of chondroid calcification. Treatment involves removal of the loose bodies with or without synovectomy.
560
Diabetic Myonecrosis:
Infarction of the muscle seen in poorly controlled type 1 diabetics. It almost always involves the thigh (80%), or calf (20%). You should NOT biopsy this: it delays recovery time and has a high complication rate.
561
Diabetic Myonecrosis on MRI
Marked oedema with enhancement and irregular regions of muscle necrosis.
562
Lipoma Arborescens:
- affects the synovial lining of the joints and bursa - "frond-like" deposition of fatty tissue. - late adulthood (50's-70's) - most common location - the suprapatellar bursa of the knee.
563
"frond-like" deposition of fatty tissue.
Lipoma Arborescens
564
Lipoma Arborescens association
often associated with OA, Chronic RA, or prior trauma
565
Lipoma Arborescens on MRI
Behaves like fat - T1 and T2 bright with response to fat saturation Chemical shift artifact at the fat-fluid interface on gradient Usually unilateral
566
Lipoma Arborescens on US
"frond-like hyperechoic mass" and associated joint effusion.
567
Circumferential calcifications with a lucent center
Myositis Ossificans
568
Lesion on the posterior medial epicondyle of the distal femur. Hot on bone scan.
Cortical dermoid - actually a tug lesion from the medial gastrocnemius and ADDuctor magnus.
569
Lytic appearing lesion in the anterosuperior femoral neck.
Synovial Herniation Pit "Pitt's Pit"
570
OA appearance
Joint spacenarrowing (NOT symmetric), subchondral cysts, endplate changes, vacuum phenomenon OSTEOPHYTES
571
Neuropathic joint appearance
Deformity, with Debris, and Dislocation, having Dense subchondral bone, and Destruction of the articular cortex a bad joint followed by the reason for a bad joint eg syringomyelia, spinal cord injury "Surgical Like Margins."
572
Charcot Foot
Diabetic neuropathic foot - deformity, with debris, and dislocation, having dense subchondral bone, and destruction of the articular cortex - favours the midfoot eventually causing a "rocker-bottom deformity" of the foot resulting from the collapse of the longitudinal arch.
573
Erosive Osteoarthritis (Inflammatory Osteoarthritis).
"gull wing" - central erosions. It is seen in postmenopausal women and favours the DlP joints.
574
Rheumatoid Arthritis is characterized by
Osteoporosis, soft tissue swelling, marginal erosions and uniform joint space narrowing. It's often bilateral and symmetric. Classically spares the DIP joints (opposite of erosive OA).
575
Felty Syndrome:
RA> 10 years+ Splenomegaly + Neutropenia
576
Caplan Syndrome:
RA + Pneumoconiosis
577
RA in the Hand timeline -
Expect the PIP joints to be involved AFTER the MCP joints. The First CMC is classically spared (or is the last carpal to be involved). The first CMC should NOT be first.
578
Psoriatic Arthritis:
- seen in 30% of patients with psoriasis - in 90% the skin findings come first, then you get the arthritis - erosive change with bone proliferation (IP joints> MCP joints) Asymmetric SI Joint Hands, Feet, Thoracolumbar Spine
579
Psoriatic Arthritis erosions start...
The erosions start in the margins of the joint and progress to involve the central portions - "pencil sharpening" effect The hands are the most commonly affected (second most common is the feet). Up to 40% of cases will have SI joint involvement (asymmetric).
580
Mutilans
Severe bone resorption leading to soft tissue "telescoping" collapse. RA and Psoriatic arthritis
581
Reiter's Triad:
Urethritis Conjunctivitis Arthritis
582
Reiters - reactive arthritis
bone proliferation, erosions, and asymmetric SI joint involvement. Reiter's is rare in the hands (tends to affect the feet more). Reiter's favors things below the waist (like the penis = urethritis, and the foot).
583
Ankylosing Spondylitis:
- "bamboo spine" - Shiny corners (early involvement) - SI joint involvement is usually the first site (symmetric). - upper lobe predominant interstitial lung disease, with small cystic spaces.
584
Post hip replacement or revision in ank spond
Heterotopic Ossification Postoperative low dose radiation and NSAIDs to try as prophylactic therapy
585
Inflammatory Bowel Disease (Enteropathic)
20% of patient's with Crohns & UC have a chronic inflammatory arthritis Either - (A): Axial Arthritis (favors SI joints and spine) - often unrelated to bowel disease (B): Peripheral Arthritis - this one varies depending on the severity of the bowel disease.
585
Unilateral SIJ involvement
Infection
586
Asymmetric SIJ involvement
Psoriasis, Reiters
587
Symmetric SIJ involvement
Inflammatory Bowel, Ank Spond
588
Earliest sign of gout
joint effusion
589
Gout on MR
- Juxta-articular soft tissue mass (LOW ON T2). - The tophus will typically enhance.
590
Gout is
crystal arthropathy from the deposition of uric acid crystals in and around the joints. Men > 40. The big toe is the classic location.
591
Gout appearance
- Spares the Joint Space (until late in the disease); - Juxtaarticular Erosions - away from the joint. - "Punched out lytic lesions" - "Overhanging Edges" - Soft tissue tophi
592
CPPD: Calcium Pyrophosphate Dihydrate Disease
often causes chondocalcinosis Synovitis + CPPD = "Pseudogout." "degenerative change in an uncommon joint'' V common in old people
593
Pyrophosphate arthropathy is most common ...
at the knee.
594
If you see isolated disease in the patellofemoral, radiocarpal, or talonavicular joint, think =
CPPD
595
Hooked MCP Osteophytes with chondrocalcinosis in the TFCC is a classic look for
CPPD
596
Hemochromatosis:
- iron overload disease also known for CP deposition and resulting chondrocalcinosis. - similar distribution to CPPD (MCP joints) - "hooked osteophytes" at the MCP joint (like CPPD)
597
CPPD vs Hemochromatosis:
Haem - uniform joint space loss at ALL the MCP joints CPPD favors the index and middle finger MCPs. Both have hooked osteophytes
598
Hyperparathyroidism
"Subperiosteal bone resorption" Can be 1ry or 2ry Effects calcium metabolism
598
"Milwaukee Shoulder"
2ry to hydroxyapatite The articular surface changes will be very advanced, and you have a lot of intra-articular loose bodies. Old woman with Hx trauma to the joint
599
Pelvis with Narrowing or "Constricting" of the femoral necks, and wide SI joints =
Hyperparathyroidism
600
Rugger Jersey Spine =
Hyperparathyroidism
601
Superior and inferior rib notching - bone resorption =
Hyperparathyroidism
601
Resorption along the radial aspect of the fingers with brown tumours =
Hyperparathyroidism
602
"Flowing Syndesmophytes" =
Ank spond Bamboo spine
603
Diffuse Paravertebral Ossifications =
DISH Ossification of ALL
604
Focal Lateral Para vertebral Ossification =
Psoriatic Arthritis Ossification of Annulus Fibrosis
605
Fusion of the cervical spine =
Klippel-Feil Juvenile RA
606
Erosions of the Dens =
CPPD and RA famously do this.
607
Bad cervical Kyphosis =
NF1
608
DISH (Diffuse Idiopathic Skeletal Hyperostosis) :
Ossification of the anterior longitudinal ligament involving more than 4 levels with sparing of the disc spaces NO sacroiliitis (to tell from AS)
609
OPLL (Ossification of the Posterior Longitudinal Ligament):
- associated with DISH, ossification of the ligamentum flavum, and Ankylosing Spondylitis - can cause spinal canal stenosis, and can lead to cord injury after minor trauma - bad in cervical, asymptomatic in thoracic - favours cervical spine old Asian men
610
Destructive Spondyloarthropathy -
- Associated with patients on renal dialysis (for at least 2 years) - Most commonly affects the C-spine. - looks like bad degenerative changes or CPPD. - Amyloid deposition is supposedly why it happens.
611
Systemic Lupus Erythematosus:
Reducible deformity of joints without articular erosions - ulnar subluxations at the MCPs on Norgaard view, then they reduce on AP (because the hands are flat). This ligamentous laxity also increases risk of patellar dislocations.
612
Jaccoud's Arthropathy:
This is very similar to SLE in the hand (people often say them together). Non erosive arthropathy with ulnar deviation of the 2nd-5th fingers at the MCP joint. The history is post rheumatic fever.
613
Mixed Connective Tissue Disease:
One unique feature is that it is positive for antibody - Ribonucleoprotein (RNP) - and therefore serology is essential to the diagnosis.
614
Juvenile Idiopathic Arthritis:
Occurs before age 16 (by definition). What you see is a washed out hand that has a proximal distribution (carpals), and is ankylosed (premature fusion of growth plates). Serology is often negative (85%). In the knees, you see enlargement of the epiphyses and widened intercondylar notch - similar to findings in hemophilia.
615
"Epiphyseal Overgrowth" =
Juvenile Idiopathic Arthritis
616
Amyloid Arthropathy: who gets it?
Patients on dialysis (less commonly in patients with chronic inflammation such as RA). When associated with dialysis, it's rare before 5 years of treatment, but very common after 10 years (80%).
617
Pituitary Gigantism:
"widening of the joint space in an adult hip" (Late in the game, the cartilage will outgrow its blood supply and collapse, leading to early onset osteoarthritis. The formation of endochondral bone at existing chondro-osseous junctions results in widening of osseous structure.)
618
Red marrow found in the humeral heads and femoral heads of an adult =
Normal variant
619
As a child, you have diffuse red marrow except for -
ossified epiphyses and apophyses.
620
As adults, you have yellow marrow everywhere except in the -
axial skeleton, and proximal metaphyses of proximal long bones.
621
Red marrow on MRI
Red marrow is darker than yellow (near iso-intense to muscle) on T1
622
Amyloid Arthropathy:
The joint space is typically preserved until later in the disease. The pattern of destruction can be severe - similar to septic arthritis or neuropathic spondyloarthropathy. The distribution is key, with bilateral involvement of the shoulders, hips, carpals, and knees being typical. Carpal tunnel syndrome is a common clinical manifestation.
623
What is the normal pattern of marrow conversion ?
The epiphyses convert to fatty marrow almost immediately after ossification. Distal then proceeds medial / proximal (diaphysis first, then metaphysis).
624
What is the normal pattern of REconversion of marrow?
The reverse order of normal marrow conversion - - beginning in the axial skeleton and heading peripheral - the last to go are the more distal long bones. Typically, the epiphyses are spared unless the hematopoietic demand is very high.
625
What areas are spared/normal variants from marrow conversion?
Patchy areas of red marrow may be seen in the proximal femoral metaphysis of teenagers. Distal femoral sparing is seen in teenagers and menstruating women.
626
leukemia and bone marrow conversion -
Proliferation of leukemic cells results in replacement of red marrow.
627
Leukemia on MRI
T1 - Marrow will look darker than muscle (and normal discs) STIR - marrow may be brighter than muscle because of the increased water content T2 is variable, often looking like diffuse red marrow.
628
Lucent metaphyseal bands in a kid =
Leukaemia
629
T1 of a spine showing marrow darker than adjacent discs and muscle =
Leukaemia Red marrow is still 40% fat and should be brighter than muscle on T 1.
630
Chloroma (Granulocytic Sarcoma)
"destructive mass in a bone of a leukemia patient." It's some kind of colloid tumor.
2a
flashcards
Decks in class (10)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions