8c. MSK pathologies

Question 1

what is the function of a joint

Answer 1

controlled movement and for stability

Question 2

what constitutes as a synovial joint

Answer 2

articular cartilage over bone

synovial lined joint capsule with synovial fluid

Question 3

what do ligaments connect

Answer 3

bone to bone

Question 4

what do tendons connect

Answer 4

muscle to bones

Question 5

what is acute trauma

Answer 5

bone cartilage and soft tissues (tendon/ligament/muscle) involved

Question 6

what is chronic trauma

Answer 6

wear and tear

eg OA (bone, articular cartilage) or rotator cuff (tendon)

Question 7

what joint is critical space for rotator cuff injuries

Answer 7

joint between acromion and HOH

Question 8

what is the rotator cuff muscles

Answer 8

tendons that surround the shoulder joint

Question 9

what are the 4 rotator cuff muscles

Answer 9

supraspinatus, infraspinatus, teres minor, subscapularis

Question 10

what causes rotator cuff tears

Answer 10

repetitive overhead activities with arms up

Question 11

what is rotator cuff tear

Answer 11

progressive degeneration of the supraspinatus tendon which is worn down or torn in sub acromial space

Question 12

what is chronic trauma of the rotator cuff

Answer 12

reduced sub acromial space due to osteophytes

Space between head of humerus and acromion is gone - very little space for supraspinatus tendon to attach on HOH, bits that go through will get worn out by osteophytes caused by degenerative joint

Question 13

what happens to the torn tendon and muscle when there is a chronic rotator cuff trauma

Answer 13

Worn away and snapped so muscle retracts and muscle undergoes fatty degeneration and this increases over time

Question 14

what movement is difficult when there is a chronic rotator cuff trauma

Answer 14

Difficult to abduct arm overhead without supraspinatus

Question 15

if a fracture goes through the joint surface what can happen

Answer 15

degenerative disease

Question 16

what is done to shoulder dislocations before imaging

Answer 16

it is reduced

Question 17

what are 3 scenarios in which shoulder dislocations are imaged

Answer 17

complex injury

post reduction to look for defect or fracture such as hill sach defect in HOH

planning corrective surgery

Question 18

what is considered as a complex fracture dislocation

Answer 18

chunk of bone pulled off

If muscle is attached to bone fragment and it retracts that bit of bone will never heal as the muscles will pull it apart

Question 19

what can happen if you dont oppose a glenoid fracture

Answer 19

can end up with OA

Question 20

why can hill sach occur in head of humerus in shoulder dislocations

Answer 20

in people with chronic shoulder dislocations each time the shoulder is dislocated it has chipped away at some of the HOH bone so gets hill sachs

Question 21

what 2 structures is the coronal section good for looking at

Answer 21

menisci and cruciate ligaments

Question 22

how is menisci tears related to blood supply and healing

Answer 22

There is only blood supply to outer 25-30% of meniscus itself, if its in the center of the menisci it wont heal, need to chop it out rather than have it become loose body in joint

Question 23

what happens when there is a full/partial tear in the cruciate ligament rupture and what is seen on imaging

Answer 23

area will be edematous and thick so will be bright on T2 MRI

Question 24

what is a haemarthrosis

what are the layers and why

Answer 24

Fracture complex of tibia and blood from bone marrow of tibia has leaked into joint and there is fat anterior to the joint

Fat is lighter than blood so sits on top of blood in joint

Question 25

what is the danger with haemarthrosis

Answer 25

Danger is that fat can get into veins and get to lungs causing fat emboli

Question 26

in a knee dislocation what is a worry

Answer 26

Worried about integrity of the structures behind the knee

Question 27

what are the structures behind the knee

Answer 27

Popliteal artery, vein and tibial and peroneal nerves

Question 28

what can happen to the structures behind the knee in a posterior knee dislocation

Answer 28

Tibia displaced posteriorly and can press on artery behind it and could get ischemia of muscles below site of obstruction which is worse situation of injury can end up with gangrenous leg that needs amputation Reduced blood flow below dislocation

Question 29

what is haemarthrosis hemophilia

Answer 29

inherited condition where there is reduced ability of the blood to clot and can bleed into the joints after trivial trauma

Question 30

what can be a severe outcome of haemarthrosis hemophilia

Answer 30

End up with joint full of blood and can lead to early arthritis that destroys the join

Question 31

what is the tibiofibular joint in the ankle responsible for

Answer 31

dorsi/plantar flexion

Question 32

what is the subtalar joint in the ankle responsible for

Answer 32

inversion/eversion

Question 33

what is MRI good for in imaging ankles

Answer 33

imaging tendons

Question 34

what is CT good for in imaging ankles

Answer 34

fractures and reconstructions

Question 35

what happens if tendons rupture or tear

Answer 35

becomes oedematous

Question 36

what is osteoarthritis

Answer 36

articular cartilage breakdown causes inflammation in joint

Question 37

can OA be reversed

Answer 37

no

Question 38

what does OA affect

Answer 38

entire joint - bone and connective tissues

Question 39

what is OA treated with

Answer 39

pain relief and joint replacement

Question 40

what are 7 risk factors for OA

Answer 40

``` older age F>M obesity joint injuries repeated stress on joint genetics metabolic diseases ```

Question 41

what are 7 symptoms of OA

Answer 41

``` pain stiffness loss of flexibility grating sensation bone spurs around edge of joint swelling depression/sleep disturbances ```

Question 42

what are 3 characteristics of OA on images

Answer 42

loss of joint space osteophytes sclerotic margins

Question 43

what can happen to osteophytes in joints in terms of OA

Answer 43

overgrowth of bone can break off into joint

Question 44

what is rheumatoid arthritis

Answer 44

chronic systemic inflammatory disorder due to autoimmune disorder that affects the synovium of joints

Question 45

what are 3 characteristics symptoms of rheumatoid arthritis

Answer 45

painful swelling bone erosion joint deformity

Question 46

what does rheumatoid arthritis do to synovial

Answer 46

thickens synovium

Question 47

what happens to ligaments in rheumatoid arthritis

Answer 47

become lax resulting in joint deformity

Question 48

what are 4 rheumatoid arthritis symptoms

Answer 48

tender/war/swollen joint joint stiffness fatigue/fever/loss of appetite severity can alter between flares and remission

Question 49

what is a radiographic characteristic on images in terms of rheumatoid arthritis

Answer 49

symmetrical

Question 50

what joints do rheumatoid arthritis affect first

Answer 50

smaller joints first

Question 51

what does rheumatoid arthritis do to the synovium and cartilage/bone

Answer 51

thickens synovium destroys cartilage and bone

Question 52

what does rheumatoid arthritis do to tendons and ligaments

Answer 52

weaken and stretch

Question 53

what are 5 risk factors for rheumatoid arthritis

Answer 53

``` F>M family hx smoking environmental exposures obesity ```

Question 54

what are 7 complications of rheumatoid arthritis

Answer 54

``` osteoporosis rheumatoid nodules infections dry eyes and mouth abnormal body composition carpal tunnel syndrome heart problems, lung disease, lymphoma ```

Question 55

what are 3 things that are characteristic in the appearance of rheumatoid arthritis in images in terms of what the bone looks like

Answer 55

bone looks moth eaten and there are round lesions/multiple areas of lucency where nodules have destroyed the bone

Question 56

what is gout

Answer 56

deposition of monosodium urate crystals in and around joints

Question 57

what is clinical presentation of gout

Answer 57

acute gouty - monoarticular red inflamed swollen joint

Question 58

where does gout normally occur

Answer 58

typically in lower limb usually affecting the first metatarsophalangeal joint

Question 59

what 2 phases are there with gout

Answer 59

acute phase 7-10days | asymptomatic period between acute flares

Question 60

what is gout associated with

Answer 60

chronic uncontrolled hyperuricemia and kidney disease

Question 61

people with gout can develop what

Answer 61

tophaceous gout chronic inflammatory and destructive changes in surrounding connective tissues

Question 62

what are tophi

Answer 62

solid urate crystal collections

Question 63

how to tophi appear on images

Answer 63

radiopaque

Question 64

what are the 3 radiographic features of gout

Answer 64

punched out lytic bone lesions with overhanging sclerotic margins periarticular soft tissue swelling due to crystal deposition in tophi around joints soft tissues swelling may be hyperdense due to crystal

Question 65

what is joint infection commonly associated with

Answer 65

joint replacement and intervention such as steroid injections

Question 66

what is joint infection seen as on images

Answer 66

lucency around bone destruction in later stage pus around prosthetic implant

Question 67

joint infections with pus around prosthetics will result in what

Answer 67

will be loose so may fall out or bone could break so need to take out joint replacement and put another one in

Question 68

what is scurvy caused by

Answer 68

vit C deficiency

Question 69

is scurvy treatable

Answer 69

yes

Question 70

who is scurvy most prevalent in

Answer 70

low socioeconomic status and smokers

Question 71

what occurs in scurvy and where do they occur

Answer 71

metaphyseal abnormalities distal femur and proximal and distal tibia sub ephyseal horizontally oriented foci of lucency with intervening parallel bands of sclerosis

Question 72

why does low vit c lead to scurvy

Answer 72

low levels of circulating vit C results in poor collagen fiber formation that leads to demineralized bones, microfractures and poor healing

Question 73

who is ewing sarcoma more common in

Answer 73

<20years | M>F

Question 74

what is ewings sarcoma associated with

Answer 74

large soft tissue component

Question 75

where does ewings sarcoma occur in

Answer 75

ribs limbs

Question 76

what are the 3 components in ewing sarcoma in radiographic images

Answer 76

bone destruction onion skinning over periosteum soft tissue mass

Question 77

what is pigmented villonodular synovitis in terms of what is affected

Answer 77

diffuse/localized hyperplastic outgrowth of synovial membranes of joints, bursae, tendon sheaths, or combo of these tissues

Question 78

what can pigmented villonodular synovitis be considered as

Answer 78

benign tumor of the synovium

Question 79

what can pigmented villonodular synovitis do to the surrounding structures if left untreated

Answer 79

displays aggressive invasion to adjacent bone and cartilage

Question 80

what is hemosiderosis

Answer 80

disorder of RBC function that results in deposition of iron in bones

Question 81

hoe does hemosiderosis appear on images

Answer 81

dark areas on T2 MRI due to iron deposits

Question 82

what is sickle cell disease

Answer 82

disorder of haemaglobin in RBC

Question 83

wat is sickle cell disease caused by

Answer 83

deformation and early destruction of red cells

Question 84

what can sickle cell disease lead to

Answer 84

ischemia and infarcts

Question 85

how can sickle cell disease appear on imaging

Answer 85

diffuse diminished bone density with prominent trabecular pattern of spine and pelvic bones