From CTC Flashcards
(129 cards)
1
Q
Mid Carpal dislocation A/W?
A
Triquetro-lunate interosseous lig disruption
Triquetral Fracture
2
Q
Perilunate A/W
A
scaphoid fracture
3
Q
Lunate dislocation A/W?
A
(most severe one)
a/w dorsal radiolunate ligament injury
4
Q
Lig injury with DISI
what is DISI
A
Scapholunate injury (radial sided)
lunate rocks dorsal
5
Q
Flexor dig’s
which attach where
A
Superficialis - PIP volar plates and base of middle
Profundus - base of distal
6
Q
ulnar negative variance a/w?
A
Kienbock (lunate AVN)
7
Q
TFCC injury healing
TFCC tendon
A
peripheral (ulnar side) = red zone, vascular, will heal
ECU
8
Q
Best view for Hill’s sack
A
INTERNAL ROTATION
9
Q
posterior disloc locked how?
A
internal rotation
10
Q
types of shoulder plasty depend on?
A
cuff or glenoid intact?
Both yes = resurfacing or hemi
cuff blown = reverse
cuff and glenoid out = Reverse
Good cuff, bad glenoid = TSA
11
Q
TSA complx
MC
Reverse complx
A
TSA MC = loosening of glenoid component
anterior escape = subscap failure
Reverse complx = posterior acromion fracture (delt tugging)
12
Q
MC site for hip labral injury
A
Anterior superior
13
Q
leg fixed how in posterior hip disloc
A
foot internally rotated
14
Q
hip fracture and AVN, risk depends on?
A
degree of displacement
15
Q
Segond
A
lateral
joint capsule avulsion fx
ACL
internal rotation
16
Q
Reverse segond
A
medial
PCL
external rotation
17
Q
arcuate sign/fx
A
avulsion of prox fibula
PCL
18
Q
intercondylar notch sign
A
LATERAL condyle
19
Q
patella alta a/w?
A
SLE
20
Q
Pilon fx
A
comminuted and intra-articular
talus driven into tibial plafond
21
Q
Tillaux
A
Salter 3 of lateral distal tibia
22
Q
Triplane
A
think 3 parts so Salter 4
23
Q
5th metatarsal fractures
A
Stress more distal than Jones
avulsion most proximal (peroneus brevis)
24
Q
No trauma medial femoral condyle edema?
A
SONK (actually a insufficiency fracture)
25
osteomalacia etiology/histology
excessive, uncalcified osteoid
26
osteomal = looser zones
where
what
femoral neck and pubic rami
symmetric, lucency with adjacent sclerosis
90 degrees to cortex
27
Synovial/joint spaces that communicate
wrist
Pisiform recess and radiocarpal joint
piss fluid is normal
28
Synovial/joint spaces that communicate or don't?
Shoulder
Glenohumeral joint and subacromial bursa
DONT communicate. fluid in the bursa = cuff tear
29
Synovial/joint spaces that communicate
Ankle
Ankle joint and peroneal tendon sheath
SHOULD NOT
= Tear of calcaneofibular ligament
30
Intersecting syndrome
what crosses what
tenosynovitis of what
first crossing over second (extensor compartments)
ECR longus and brevis
(If you remember this you deserve Extra CRedit)
31
Tenosynovitis
Diffuse or focal
Diffuse
- Non-TB mycobacterial - hand and wrist MC, diffuse and exuberant, spares the muscles, immunocompromised
- **RA - multiple flexor tendons** or ECU (can be very early RA)
Focal
- Overuse (DQ's)
- Infection - involvement of a **flexor surgical emergency**
32
Dupuytren contracture
"classics" to the story
Northern European alky
nodular mass on palmar aspect of aponeurosis --\> 'cord-like thickening' and contracture
Usually 4th finger
half bilateral
33
Glomus finger tumor
benign, vascular, hamartoma
PAINFUL
T2 bright
34
GCT of tendon sheath
PVNS of tendon
T1 and T2 dark
**bloom on GRE**
**No bloom = fibroma**
35
UCL tear
**valgus** overload
attaches to **sublime** tubercle
**anterior bundle** most important
T sign
36
Tennis elbow
**Lateral** epicondylitis
ECRB
37
Golf elbow
medial
common flexor tendon and ulnar nerve chronic injury
38
classic for cat scratch
epitrochlear LAD
39
AC joint separation
?ligaments
**acromioclav and coracoclav**
40
**External** impingement
Primary =
coracoacromial arch
hooked acromion, subacromial o'phyte, subcoracoid (impinges on subscap, first two on suprascap)
Secondary =
multidirectional glenohumeral instability (microtrauma in all directions) lax joint
41
**Internal** impingement
**posterior superior**- overhead movements, ABER view
**Greater tuberosity and posterior inferior labrum do the pinching**
anterior superior - biceps and subscap tendons
42
Frozen shoulder MRI look
loss of fat in the rotator cuff interval (by biceps tendon, btw supra-s and sub-scap)
interval also enhances
43
SLAP
type IV
stable?
mechanism?
Typer 4 involves long head biceps tendon
Not usually unstable
a/w overhead movement
44
sublabral **recess**
sublabral **foramen**
recess - mimics SLAP, points towards head
foramen, unattached labrum from 1 to 3 o'clock
45
HAGL
humeral avulsion glenohumeral ligament
anterior dislocation related
**avulsion of inferior glenohumeral ligament**
torn and 'J-shaped' retracted from humerus
46
biceps tendon sublux
**subscap attaches to lesser tuberosity**
sends some fibers over bicipital groove to greater tuberosity as the **transverse ligament**
**subscap tear --\> medial disloc of long head tendon**
47
Magic angle
Short TE (T1, PD, GRE)
PCL and patellar tendons
foci of intermediate signal
55 degrees
48
Meniscal tears
**Vertical** = radial or longitudinal
## Footnote
**Horizontal**
49
Bucket handle tear
usually medial
flips anterior 'double PCL'
indirectly proves ACL is intact. Wont get double PCL with a torn ACL
50
ACL kissing contusions
lateral fem condyle and posterolat tibial plateau
51
ACL repair 'roof impingement'
'isometry'
**tibial tunnel** too far anterior = **impingement**
tibial tunnel = primary factor in preventing impingement
**isometry** = constant length and tension of graft
primary factor for isometry = f**emoral tunnel**
52
ACL repair graft tear
when
look
During remodeling (4-8 months)
increased T2 signal
53
Ankle avulsions
above/lateral to lateral mal
medial/below lateral mal
above/lat = superior peroneal retinaculum avulstion
medial/below = ATFL/calcaneofib
54
inversion ankle injury
ATFL
55
primary arch stabilizer
acute injury where
chronic injury where
PTT
acute at navicular insertion
chronic behind medial mal
56
Chronic ankle pain, h/o inversion injuries
split peroneus brevis
C shaped, or boomerang or 3 tendons
57
Anterolateral impingement
mass of hypertrophic synovial tissue from ATFL and tibiofibular ligament injury causing lateral instability and chronic inflammation T1 and T2 dark mass in lateral ankle
58
tarsal tunnel
1st three toes, tibial nerve
tunnel behind med mal
usually unilateral
59
medial clear space ligament
delt
60
Morton
where
look
bt **3rd and 4th metatarsal heads**
scar, perineural fibrosis **T1 dark**
**entrapment of plantar digital nerve by intermetatarsal ligament**
61
Osteomyelitis factoids in kids
\< 1 month
\< 18 months
2-16 years
**\< 1 month** multicentric, often involve joints, **bone scan negative**
**\< 18 months** spreads to physis through blood
**2-16 years \>** physeal vessels closed, growth plate is a barrier, hangs out in metaphysis
62
Potts look
spares disc
multiple levels
large, calcified psoabscesses
**Gibbus = destructive focal kyphosis**
63
Rice bodies
sloughed infarcted synovium a/w end stage RA and TB infection of joints
64
TB fingers
kids
TB dactylitis
smoldering, no PO reaction
diaphyseal expansile lesion with soft tissue swelling
65
paro vs peri
location
age
parosteal usually metaphyseal
peri tends to be diaphyseal
peri = younger (15-25)
66
Chondrosarc RF
Pagets
maffuccis
osteochondromas (peripheral. others intramedullary)
67
epiphyseal lucent
kid vs adult
kid maybe chondroblastoma (thin sclerotic rim)
## Footnote
**Adult think clear cell chondrosarcoma (usually bigger)**
68
permeative dyaphyseal lesion in a kid
EWINGS
infection
EG
69
Ewings
skipping white kid
mets to bone, whites, kids
70
MFH (PUS)
who
where
look
complx
old people
central (proximal arms and legs)
T2 dark
spontaneous hemorrhage --\> hematoma
71
Synovial sarcoma
look
location
MC malignancy in teens/**young adults** of foot/ankle/lower ext
**Easily mistaken for a Baker cyst**
**peripheral, near joints**
**complex, flow**
**bowl of grapes, diff signals, calcs**
**CAN attack bones (other sarcs don't)**
**HURT (other sarcs don't)**
**Bony erosions, slow growing**
72
Young person liposarc variant
myxoid liposarc
MC liposarc \< 20 y
T1 dark T2 bright (LOOK LIKE A CYST)
**will enhance**
73
hemangioma
unique shit
phleboliths (get an xray)
flow voids
74
mazabraud
**Polyost fibrous dysplasia** with soft tissue **myxomas**
75
Unique tx
O'sarc
Ewing
Chondrosarc
GCT
O'sarc - **chemo** then wide excision
Ewing - **chemo and RT** then excision
Chondrosarc - **Just excision**
GCT - Usually needs **arthroplasty** (extends to articular surface)
76
benign parost mimic
Cortical desmoid
(posterior distal femur)
can be hot on bone scan
77
Four horsemen of the apophysis
**A**BC (crosses closed growth plate)
**I**nfx
**G**iant cell
**C**hondroblastoma
78
Epiphyseal equivalents
patella
calcaneus
carpals
greater troch
79
fibrous dysplasia
mono vs poly age
look
mono 20s and 30s
poly \< 10 yo
disorder of **o'blasts**
variable with phases
long lesion, long bone, ground glass
no pain or perio rxn
80
FD femur
shepherd's crook
FD of pelvis also involves ipsi femur
81
2 polyostotic fibrous dysplasia syndromes
McCune Albright - girl, precocious puberty
Mazabroud - myxomas and risk of malig transformation
82
weird look for EG
floating tooth
lyitc lesion in alveolar ridge
83
GCT needs
a/w lesion
?mets
closed physis (20-30 yo)
ABC
lung mets (curable)
84
GCT vs NOF
**GCT NON sclerotic border**
**NOF sclerotic**
85
lytic or sclerotic with hyperparathyroidism
what
where
Brown tumor
side of a finger
under clavicle
under a rib
86
CMF
eccentric, lytic metaphyseal,
BITE configuration
looks like a NOF kinda
87
HIP COMMONS by spot
GREATER
LESSER
INTER
**Greater = AIGC**
**LESSER = pathologic avulsion**
**INTER = Lipoma, unicameral, monostotic fibrous dysplasia**
88
POEMS
**myeloma with sclerotic mets**
with neuropathy and organomegaly
89
calcaneal lesion with central calc
lipoma
90
random intertroch lytic lesion with a sclerotic margin
liposclerosing myxofibroma
91
coxa profunda
deep tab
vs protrusio
92
worrisome cap size
\> 1.5 cm
93
bilateral weird, enlarged prox femurs =
mult hered exostoses, sessile
coxa magna
94
**avian spur** possible complx
## Footnote
**points toward joint**
**o'chondromas point away**
median nerve compression
ligament of struthers
95
adamantinoma look alike (same thing?)
osteofibrous dysplasia
anterior tibia, bowing
looks like a NOF
96
oa vs ra tab
OA straight up or straight medial
## Footnote
**RA DIAGONAL IN**
97
Reiters basic look
psoriatic usually sparing hands
SI joints and feet
98
Ank spond goes where first
SI joints
| (then spine)
99
non spine/SI ank spond?
hips \> shoulders
horrible heterotopic ossification after hip replacements
100
Ank spond associations
**uveitis**
**upper lung interstitial dz (cysts and fibrosis)**
**aortic insufficiency**
101
MC ank spond fx site?
**lower C spine**
102
CPPD things
chondrocalcinosis
Loves TFCC
unusual joints (radiocarpal, shoulder, elbow, patellofemoral)
hooked phytes (also with Fe)
can cause SLAC
103
CPPD vs Fe
BOTH chondrocalcinosis
BOTH hooked phytes
**Fe at ALL THE MCP's**
**CPPD INDEX and MIDDLE**
104
hyperparathyroidism looks
radial sided resorption
tuft resorption
brown tumors
rugger spine
105
Dens erosions
**CPPD and RA**
106
Like SLE hands?
Jacoud
non erosive
ulnar sublux of 2nd -5th at MCP
**POST RHEUMATIC FEVER**
107
spine of HD patient x 2 years
Destructive Spondyloarthropathy
ugly C spine
2/2 amyloid deposition
108
Juvenile idiopathic RA
jacked up carpals \<16 yo
negative serology
epiphyseal overgrowth
widened intercondylar notch
109
long term HD 'itis
Amyloid arthropathy
bilateral shoulders, hips, carpals, knees - severe destruction
carpal tunnel
joint spaces preserved until later
110
THA degen
along diag axis (the RA one) = creep = normal
wear = abnormal = superior-lateral
111
Red marrow persists where in adulthood
axial skeleton and **proximal metaphyses of prox long bones**
112
poikylosis
bone islands that **favor epiphyses**
## Footnote
**peri-articular**
**keloid formers**
113
Engelmann's
progressive diaphyseal dysplasia
fusiform **long-bone boney enlargement with sclerosis**
**bilateral**
**symmetric**
**usually tibia**
**bone scan hot**
**skull --\> optic nerve compression**
114
PVNS
where
what
joint synovium or tendon sheath
## Footnote
**synovial prolif and Fe deposition**
**knee by far MC**
115
PVNS look
xray - joint effusion +/- **marginal erosions**
**joint space preserved**
**normal mineralization**
**MRI BLOOMING on GRE**
116
PVNS tx?
complete synovectomy
117
PVNS in the hand
**GCT of tendon sheath**
**erosions**
**T1 and T2 dark**
**glomus T2 bright and avid enhancement**
118
mutiple uniform ring and arc calc joint bodies
primary synovial chondromatosis
- true neoplasia/metaplasia
tx = scope and remove +/- synovectomy
PVNS never calcifies
119
Gigantism mechanism
formation of endochondral bone at existing chondro-osseous junctions
---\> widening of osseous structure
120
AVN rim sign
T2 oreo with bright **fluid between sclerotic borders of an osteochondral fragment**
## Footnote
**stage III instability**
121
Pagets 3 phases
lytic - asymp
mixed - fractures, elevated alk phos
sclerotic - more fractures and cancer
122
Pagets look
**wide bones with thick trabecula**
123
pagets in a long bone
lytic
blade of grass
lucent leading edge
124
Pagets spine, skull
Picture frame
tam o shanter thick skull
125
Pagets complications
**MC = Deafness**
**Spinal stenosis**
stress fractures
CHF
2ary hyperparathyroidism
alk phos way way elevated
126
Pagets tx
bisphosphonates
127
Pagets skull look
lytic = frontal and occipital **(circumscripta)**
mixed = cotton wool
**involves both inner and outer tables**
FD just outer
128
normal coracoclav distance
1.3 cm
129
subscap insertion
lesser tuberosity
