3.2 MSK Pathology

Question 1

Name the 7 Pathologies we cover in MSK?

Answer 1

1. Tears
2. Inflammation (tendonitits/peritenditis)
3. Ganglion Cysts
4. Popliteal/Bakers cyst
5. Carpal Tunnel Syndrome
6. Tumours
7. Foreign bodies

Question 2

4 factors that contribute to a tendon tear? (weakening of tendon)

Answer 2

Age
Calcification
Corticosterioids (commonly used to treat inflamm)
Systemic diseases (arthritis, DM, Lupus, gout)

Question 3

What are the 2 different types of tendon tears?

Answer 3

Complete (often clinical diagnosis, may not need US)

Incomplete (tendinitis symptoms)

Question 4

What are complete tears?

Answer 4

Torn all the way in half

gap/defect can be of variable length

Question 5

What are incomplete tears?

Answer 5

Focal defect of tendon attachment, partially torn.

Question 6

Tendon tears are sonographically variable name 6 things it could have.

Answer 6

1. Hypoechoic defects ( watch for anisotrophy)
2. Focal thinning
3. Architectural distortion (fibers look distorted)
4. Fluid filled defects
5. Echogenic deposits if chronic
6. Possible non-visualization of tendon

Question 7

Rotator Cuff Sonographic Complete tear appearance

Answer 7

Deltoid sits directly on humerus head (normally deltoid, supraspinatus, HH)
CARTILIAGE INTERFACE sign

Question 8

What is the cartilage interface sign

Answer 8

Thin, hyperechoic line at interface between normally hypoechoic cartilage and the ABNORMALLY hypoechoic tendon

Question 9

Rotator Cuff Sonographic small incomplete tear appearance

Answer 9

Rim Rent Sign

Question 10

What is the Rim Rent Sign?

Answer 10

Comma shaped, focal abnormal echogenicity within the tendon

Question 11

Rotator Cuff Tear Sonographic Associated sign

Answer 11

Join effusion (fluid in joint space)
Irregularity of bony surface (GT area)
Geyser sign (collection fluid superior to AC joint)

Question 12

Inflammation of the tendon is known as

Answer 12

Tendonitis

Question 13

Tendonitis is often___ or ___ related

Answer 13

sport or work

Question 14

Inflammation of the tendon can be___ or ___

Answer 14

Diffuse or focal

Question 15

Inflammation can present with what 2 things?

Answer 15

Edema of tissue or

calcifications if chronic

Question 16

What is the hallmark feature of tendonitis?

Answer 16

TENDON THICKENING

compare to contralateral side

Question 17

Tendonitis sonographically

Answer 17

decrease echogenicity (watch technique)
Hypermia (increased blood flow, usually poor Blood supply )
Possible calcifications (chronic)

Question 18

3 other inflammation of tendons ?

Answer 18

1. Peritendinitis
2. Tenosynovitis
3. Bursitis

Question 19

What is peritendinitis?

Answer 19

inflammation to the CT that surrounds the achilles

Question 20

What is Tenosynovitis?

Answer 20

inflammation of the tendon sheath (fibrous sheath surrounding many other tendons in body)

Question 21

What is Bursitis?

Answer 21

Inflammation of a Bursa
often due to trauma or microtrauma
Sonolucent collection with ill-defined walls

Question 22

What are ganglion cysts?

Answer 22

Benign soft tissue tumor typically in hand or wrist

palpable mass, focal pain

Question 23

What are ganglion cysts sonographic appearance ?

Answer 23

Cystic mass attached to tendon sheath
oval fluid collection with enhancement
may contain debris
Chronic may have more hypoechoic solid appearance

Question 24

Popliteal cyst is known as a?

Answer 24

Bakers cyst (Synovial cyst of the knee, pop fossa)

Question 25

The popliteal cyst is a dilated

Answer 25

Dilated

Question 26

The popliteal cyst is located?

Answer 26

Posteromedial

Question 27

The popliteal cyst is associated with

Answer 27

Rheumatoid arthritis

Question 28

The popliteal cyst can be ___ or ____

Answer 28

Symptomatic (can mimic DVT or thrombophlrbitis) or Asymptomatic

Question 29

The popliteal cyst have the potential to ?

Answer 29

rupture and dissect down the calf

Question 30

What is encroachment of the medial nerve?

Answer 30

CARPEL TUNNEL SYNDROME

Question 31

Carpel tunnel can be a result of which 2 things?

Answer 31

Decrease in tunnel size | Increase in volume within the space

Question 32

What will the patient present with, with carpel tunnel syndrome?

Answer 32

Pins and needles

Question 33

Does US usually diagnosis Carpel tunnel? Y or N

Answer 33

No

Question 34

No the best way.. but Carpel tunnel imaging signs include(4)

Answer 34

1. a nerve that is 3x bigger in one axis than another axis 90 degrees 2. loss of honeycomb appearance in SAX 3. Increase or decrease in countour/size LAX Increase in cross-section area when compared to other side

Question 35

What are 3 Benign tumors in MSK?

Answer 35

1. Giant cell tumors 2. Osteochondroma 3. Lipoma

Question 36

Giant cell tumors are?

Answer 36

Benign tendon sheath tumors

Question 37

Giant cell tumors sonographically (2)

Answer 37

Hypoechoic masses with lobulated contour

Question 38

Osteochondroma are?

Answer 38

Benign cartilaginous tumors, can develop in a popliteal cyst

Question 39

Osteochondroma sonographically (2)

Answer 39

Hyperechoic area with posterior shadowing

Question 40

Lipomas are?

Answer 40

Tumors compossed of fat or adipose tissue | compressible, mobile and painless

Question 41

Lipomas sonographically (2)

Answer 41

Often hyperechoic but depends on surrounding tissue

Question 42

US used to Identify nonradio or radio-opaque Foreign Bodies, this means ?

Answer 42

They Do not show up on x ray (nonradio) | or do show up on US (radio) but want more info with US on where it is located.

Question 43

Soft tissue can be examined for _______ inflammatory changes (like abscess)

Answer 43

secondary

Question 44

Metal Foreign Bodies sonographically (2)

Answer 44

``` Hyperehcoic Comet tail (metal) ```

Question 45

Foreign Bodies Can be (3)

Answer 45

Metal, splinter or glass | US can be used for guidance.