MSK Flashcards by Tonia Forjoe

What do the following findings suggest?
Fracture
Abnormal stress on normal bone

Fatigue fracture (Stress)

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What do the following findings suggest?
Fracture
Normal stress on abnormal bone

Insufficiency fracture (Stress)

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What is the appearance of a fracture at 7-14 days?

A healing fracture will be more lucent at 7-14 days

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What do the following findings suggest?
Fracture not healed within the expected time period

Delayed union

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What do the following findings suggest?
Fracture not healing without intervention

Non-union

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What do the following findings suggest?
Union in poor anatomic position

Mal-union

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What is the most common site of stress fracture in young athletes?

Tibia

Posterior medial aspect proximal/distal 1/3

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What do the following findings suggest?
Old patient
Medial femoral condyle
T1 high signal (Oedema)
Subchondral deformity

Spontaneous osteonecrosis of the knee

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What is the most commonly fractured tarsal bone?

Calcaneum

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What is the blood flow to the scaphoid?

Retrograde (Distal to proximal)

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Which type of scaphoid fracture is most susceptible to AVN?

Proximal pole

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What is the most common fracture site of the scaphoid?

Scaphoid waist

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Which part of the SL ligament is most important for carpal stability?

What does disruption increase risk of?

Dorsal band

DISI

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What do the following findings suggest?
Atraumatic AVN of the scaphoid

Prieser disease

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What do the following findings suggest?
Injury to the SL ligament

SLAC wrist

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What do the following findings suggest?
Scaphoid fracture

SNAC

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What happens when there is a SL ligament tear?

Scaphoid tilts to volar
Radial scaphoid space narrows
Capitate migrates proximally

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What do the following findings suggest?
Scaphoid tilts to volar
Radial scaphoid space narrows
Capitate migrates proximally

Scapholunate ligament tear

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What is the scapholunate ligament preventing the scaphoid and lunate from doing?

Scaphoid wants to move volar
Lunate wants to move dorsal

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What do the following findings suggest?
Radial side injury (SL side)
Scaphoid move dorsal
Widened SL angle >60
Capitolunate angle decreased

DISI (Dorsal intercalated segmental instability)

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What do the following findings suggest?
Ulnar side injury (LT side)
Scaphoid moves volar
Narrowed SL angle <30

VISI (Volar Intercalated Segmental instability

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Which is more common DISI or VISI?

DISI

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What do the following findings suggest?
SL >3 mm
Worsened on clenched fist view

Scapho-lunate dissociation

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What do the following findings suggest?
Lunate remains in normal position
Capitate moves dorsal

Peri-lunate dislocation

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What do the following findings suggest? Lunate moves volar Capitate moves dorsal Radial alignment lost Triquetral fracture

Mid-Carpal dislocation

What do the following findings suggest? Lunate displaced and rotated volarly Capitate remains in position Dorsal radiolunate ligament injury

Lunate dislocation

Which carpal dislocation is Least severe v Most severe?

Least severe = Scapho-lunate dissociation Most severe = Lunate dislocation

Which synovial spaces in the wrist normally communicate?

Pisiform recess Radiocarpal joint

If the GHJ and Subacromial bursa in the shoulder communicate what does this mean?

Full thickness rotator cuff tear

If the Ankle joint and lateral peroneal tendon sheath communicate what does this mean?

Calcenofibular ligament tear

The following are components of what? Triangular fibrocartilage Volar & Dorsal Radioulnar ligaments Meniscus UCL Tendon sheath of UCU

TFCC

How does the TFCC appear on MR?

Dark on every sequence

Which aspect of the TFCC is most and least likely to heal?

Ulnar side = vascular, more likely to heal Radial side = Avascular, less likely to heal

What do the following findings suggest? Ulna more distal than the radius

Positive ulnar variance

What do the following findings suggest? Ulna more proximal than the radius

Negative ulnar variance

What do the following findings suggest? Positive ulnar variance Ulna hits lunate Degeneration of the lunate - cystic change TFCC disrupted

Ulnar impaction syndrome

What do the following findings suggest? AVN of the lunate 20-40s Negative ulnar variance Low T1 signal

Kienbochs disease

What do the following findings suggest? Distal radius fracture Dorsal movement of fragment

Colles fracture

What do the following findings suggest? Distal radius fracture Volar movement of fragment Extra-articular

Smith fracture

What do the following findings suggest? Distal radius fracture Volar movement of fragment Intra-articular

Reverse barton fracture

What do the following findings suggest? Distal radius fracture Intra-articular Dorsal movement of fracture

Barton fracture

What do the following findings suggest? Intra-articular fracture of radial styloid SL dissociation Perilunate dislocation

Chauffeur fracture

What doesn't go through the carpal tunnel?

Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Flexor pollicis brevis

What is found within the carpal tunnel?

4 x Flexor D profundus 4 x Flexor D Superficialis 1 x Flexor pollicis longus 1 x Median nerve

What do the following findings suggest? Median nerve distribution neuropathy - Palmar thumb to 4th digit) US - enlargement of the median nerve Thenar muscle atrophy Increased signal in median nerve

Carpal tunnel syndrome

What do the following findings suggest? Entrapment of the ulnar nerve through Guyots canal (Pisiform/Hamate)

Guyons canal syndrome

What do the following findings suggest? Increased fluid seen around tendon

Tenosynovitis

What do the following findings suggest? 1st extensor compartment (EPB/APL) Increased fluid within the 1st extensor compartment Increased T2 signal in tendon sheath

De Quervains tenosynovitis

What do the following findings suggest? Fracture of base of 1st MC

Bennett fracture

What do the following findings suggest? Avulsion fracture at base of proximal 1st phalanx UCL disruption

Gamekeepers thumb

What do the following findings suggest? Fracture of proximal ulna Anterior dislocation of radial head

Monteggia fracture

What do the following findings suggest? Radial shaft fracture Anterior dislocation of the ulna at DRUJ

Galeazzi fracture

What do the following findings suggest? Fracture of radial head + Anterior dislocation of DRUJ

Essex Lopresti (Unstable - interosseous membrane rupture)

Which side does the ulnar nerve pass?

Medial

What do the following findings suggest? Repetitive elbow extension Extensor tendon injury (ECRB) Tear of radial collateral ligament complex

Lateral epicondylitis

What do the following findings suggest? Repetitive flexion Common flexor tendon and ulnar nerve enlargement

Medial epicondylitis

Which is more common medial v lateral epicondylitis?

Lateral Epicondylitis

What do the following findings suggest? Epitrochlear lymphadenopathy

Cat scratch disease

What do the following findings suggest? Painful mass in antecubital fossa Popeye deformity

Biceps tear

What are the most common associated fractures with elbow dislocation?

Radial head & Coronoid process fracture

What do the following findings suggest? Coronoid posterior to the humerus UCL tear

Elbow dislocation

What do the following findings suggest? Posterolateral humeral head impaction fracture

Hill Sachs

What are the associated injuries with anterior dislocation?

Hill Sachs Bankart lesion

What do the following findings suggest? Anterior glenoid rim fracture (Labrum)

Bankart lesion

What do the following findings suggest? Anterior humeral head impaction fracture Posterior dislocation

Trough sign

What injuries are associated with a posterior shoulder dislocation?

Trough sign Reverse Bankart

What do the following findings suggest? Posterior glenoid rim fracture

Reverse bankart lesion

What injury is associated with an inferior dislocation?

Axillary nerve

What do the following findings suggest? Flat spot at humeral head below the level of coracoid

Pseudo-Hill sachs

What do the following findings suggest? Plastic cup on humeral head Metallic sphere on glenoid

Reverse total shoulder replacement

What is the most common type of shoulder impingement? What muscle is damaged?

Subacromial impingement Supraspinatus tendon

What are the 2 types of rotator cuff tears?

Bursal side = Top Articular side = Underside

What is the most common type of rotator cuff tear?

Articular surface (Underside)

Which is the most common rotator cuff muscle to tear?

Supraspinatus

What do the following findings suggest? T2 high signal within a rotator cuff tendon Gadolinium crossing over the cuff into the bursa

Full thickness rotator cuff tear

What do the following findings suggest? Inflammatory condition Hx of trauma/surgery T1 loss of fat in rotator cuff interval Thickened axillary fold

Adhesive capsulitis

What do the following findings suggest? Superior margin shoulder labrum tear - Labrum at insertion of long head of biceps No associated instability Seen in overhead throwers

SLAP Tear

What do the following findings suggest? Incomplete attachment of the labrum at 12 oclock Smooth margins At Biceps anchor High signal (Fluid) Follows contour of glenoid

Sublabral recess

What do the following findings suggest? Absent anterior/superior labrum (1-3 o'clock) Thickened middle GH ligament

Burford complex

What do the following findings suggest? Superficial partial labral injury Cartilage defect No instability Superficial anterior inferior labral tear

Glenolabral articular disruption (GLAD) Mild

What do the following findings suggest? Avulsed anterior-infeiror labrum Medially stripped Intact GH complex periosteum

Perthes

What do the following findings suggest? Medially displaced labroligamentous complex Labrum torn with posterior displacement Absence of labrum on glenoid rim Intact periosteum

ALPSA (Anterior labral periosteal sleeve avulsion)

What do the following findings suggest? Periosteum disrupted Cartilaginous or osseous labrum tear

True Bankart

The following shoulder injuries occur with which type of shoulder dislocation? GLAD Perthes ALPSA Bankart

Anterior shoulder dislocation

The following shoulder injuries occur with which type of shoulder dislocation? Reverse osseous Bankart POLPSA Bennet lesion Kims lesion

Posterior shoulder dislocation

What do the following findings suggest? Fracture of posterior inferior rim of glenoid

Reverse osseous bankart

What do the following findings suggest? Posterior labrum and posterior scapular periosteum Periosteum intact Recess communicates with joint space

POLPSA

What do the following findings suggest? Extra-articular curvilinear calcification Associated with POLPSA Injury of posterior band of inferior GH ligament

Bennett lesion

What do the following findings suggest? Avulsed/flattened posterior-inferior labrum Glenoid cartilage and posterior labrum relationship preserved

Kims lesion

What do the following findings suggest? Avulsion of inferior GH ligament - retracted from humerus Anterior shoulder dislocation

HAGL (Humeral avulsion GH ligament)

Where does subscapularis attach?

Lesser tuberosity

What do the following findings suggest? Tear of subscapularis Biceps dislocates medially (Long head of biceps)

Subluxation of biceps tendon

What is the effect of a cyst: - At level of supra scapular notch - Spinoglenoid notch

At level of supra scapular notch = Fatty atrophy of Supraspinatus + Infraspinatus Spinoglenoid notch = Fatty atrophy of Infraspinatus

What do the following findings suggest? Atrophy of teres minor

Due to quadrilateral space syndrome - compression of axillary nerve

The following are borders of which space? Teres minor above Teres major below Humeral neck lateral Triceps medial

Quadrilateral space

What do the following findings suggest? Atrophy of muscles supplied by supra scapular and axillary nerves

Parsonage turner syndrome (Idiopathic involvement of brachial plexus)

What is the classic femoral shaft fracture site?

Medial

In a patient with bisphospohonate therapy, what is the common fracture site?

Lateral femur

In the hip, the following lines are anterior or posterior? Iliopectineal line Ilioischial line

Iliopectineal line = Anterior Ilioischial = Posterior

What do the following findings suggest? Anastomosis of the inferior epigastric and obturator vessels riding on superior pubic ramus

Corona Mortis

Which type of fracture of the hip is at risk of AVN?

Displaced intracapsular fracture can disrupt circumflex femoral blood supply

Isolated avulsion injury of which location is suggestive of a pathologic fracture?

Lesser trochanter (Iliopsoas)

Which muscles attach to the following locations: Iliac crest ASIS AIIS

Iliac crest = Abdominal muscles ASIS = Sartorius/Tensor Fascia lata AIIS = Rectus Femoris

Which muscles attach to the following locations: Greater Trochanter Lesser Trochanter Ischial tuberosity Pubic symphysis

Greater trochanter = Gluteal muscles Lesser trochanter = Iliopsoas Ischial tuberosity = Hamstrings Pubic symphysis = Adductor group

Are the following hip fractures stable or unstable? Anterior-posterior compression Vertical sheer Lateral compression

Unstable

What do the following findings suggest? Fracture of the ischial-sacral aspect Diastasis of the pubic symphysis

Anterior posterior compression

What do the following findings suggest? Fracture of ischial-sacral aspect Fracture of superior/inferior pubic bones Upward shift

Vertical sheer

What do the following findings suggest? Fracture of ischial-sacrum Fracture of superior/inferior pubic bones Lateral rotation

Lateral compression

What is the cause of external snapping hip?

Most common Iliotibial band moving over greater trochanter

What is the cause of internal snapping hip?

Iliopsoas over iliopectineal eminence or femoral head

What is the cause of intra-articular snapping hip?

Labral tears/Joint bodies

What do the following findings suggest? Repetitive stress syndrome - runner Fluid on both sides of the IT band Extends posterior & lateral

IT band syndrome

What are the most common hip labral tears?

Anterior superior tear

What do the following findings suggest? Fluid signal mass anterior to femur (Adjacent to psoas tendon) Level of ischial tuberosity

Iliopsoas bursitis

What do the following findings suggest? Osseous bump at femoral head-neck junction More common in young male Alpha angle >55 degrees

Cam type FAI

What do the following findings suggest? Deformity of acetabulum Acetabulum is malformed causing posterior lip to cross over anterior lip More common in Middle aged woman Acetabular overcoverage

Pincer type FAI

What do the following findings suggest? Acetabulum projects medial to the ilioischial line

Coxa Profunda

What do the following findings suggest? Femur projects medial to the ilioischial line

Acetabular protrusion

What do the following findings suggest? Unfused secondary ossification center lateral to the acetabulum

Os Acetabuli

What do the following findings suggest? >2 mm lucency at interface Migration of prosthesis component

Aseptic loosening of arthroplasty

What do the following findings suggest? Hip arthroplasty Progressive lytic focal regions around replacement Joint effusions Smooth endosteal scalloping No sclerosis

Particle disease (Aggressive Granulomatosis)

What distinguishes aggressive granulomatosis from infection?

Smooth endosteal scalloping

What do the following findings suggest? Post menopause/Renal failure Honda sign - H shaped appearance

Sacral insufficiency fracture

What do the following findings suggest? Fracture of lateral tibial plateau What is it associated with?

Segond fracture ACL injury

What do the following findings suggest? Fracture of medial tibial plateau What is it associated with?

Reverse segond fracture PCL tear + Medial meniscus injury

What do the following findings suggest? Avulsion of proximal fibula Fragment at lateral aspect of knee What is it associated with?

Arcuate sign Cruciate ligament injury usually PCL

What do the following findings suggest? Depression of lateral femoral condyle

Impaction injury - Deep intercondylar notch sign Associated with ACL tears

What are the two bundles of the ACL?

AM (Anteromedial) PL (Posterolateral)

Where does the MCL attach?

Laced into the joint capsule, connected to medial meniscus

What is the conjoint tendon?

Formed by biceps femoris tendon and LCL

Which knee ligaments are intra-articular? Which knee ligaments are extra-articular?

Intra-articular = ACL + PCL Extra-articular = MCL

What do the following findings suggest? Intermediate signal on TE sagittal in PCL and patellar tendon Not seen on T2 sequences

Magic angle phenomenon

Which fractures are ACL tears associated with?

Segond fracture (Lateral tibial plateau) Tibial spine avulsion

What do the following findings suggest? ACL Tear MCL Tear Medial meniscal tear

Odonoghues unhappy triad

What do the following findings suggest? Lateral femoral condyle contusion Postero-lateral tibial plateau contusion

Kissing contusions (ACL injury)

What do the following findings suggest? No contusion T2 celery stalk of ACL - striated look T1 drumstick of ACL

ACL Mucoid degeneration

What do the following findings suggest? Post ACL repair ACL flat angle to roof of intercondylar notch Gross high T2 signal Fiber discontinuity Uncovered posterior horn of lateral meniscus

ACL Graft tear

What do the following findings suggest? Oedema of the fibular head

Posterior lateral corner fracture

What is the strongest ligament in the knee?

PCL

What is the risk of a PCL tear?

Popliteal artery disruption

Which knee meniscus is being described here: - Thicker posteriorly - Equal thickness anterior & Posterior

Medial meniscus = Thicker posteriorly Lateral meniscus = Equal thickness between anterior and posterior

What is the blood supply of the menisci?

Peripheral zone is vascular (Geniculate arteries) Central zone is avascular

What do the following findings suggest? Tear across the whole of the meniscus Truncated triangle Cleft or absent triangle

Radial tear

What do the following findings suggest? Radial tear that changes direction into the longitudinal direction (Knee meniscus)

Flap meniscal tear

What do the following findings suggest? Knee meniscus Long extension tear in the axial direction

Longitudinal tear

What do the following findings suggest? Knee meniscus Tear extends to apex Associated meniscal cyst Common in posterior horn of medial meniscus

Horizontal cleavage tear

What do the following findings suggest? >3 meniscal bowties Meniscus stretches into the notch

Discoid meniscus

What is the normal appearance of a meniscus in the sagittal plane?

2 bowtie shapes

Where is a discoid meniscus most common?

Lateral meniscus

What do the following findings suggest? Medial meniscus Vertical longitudinal tear, that flips medially to be anterior to PCL Double PCL sign <2 bowties on sagittal

Bucket handle tear

What is the significance of a double PCL tie in relation to the ACL?

A double PCL sign means the ACL is intact

What do the following findings suggest? High T2 cystic structure Horizontal cleavage tear Lateral meniscus

Meniscal cyst

What do the following findings suggest? Cystic structure between semimembranosus & Medial head of gastrocnemius

Bakers cyst

Bakers cysts are found between which muscles?

Semimembranosus Medial head of Gastrocnemius

What do the following findings suggest? Focal ossification of posterior horn of medial meniscus Associated with radial root tear Smooth cortex

Meniscal ossicle

What are the meniscofemoral ligaments?

Wrisberg = Crosses posterior Humphry = Crosses anterior Originate from posterior horn of lateral meniscus and cross around PCL

What do the following findings suggest? Ligaments that originate from posterior horn of lateral meniscus and cross around PCL

Meniscofemoral ligaments (Wrisberg & Humphry)

What is the most common dislocation of the patella?

Lateral

What do the following findings suggest? Contusion of medial patella Contusion of anterolateral femur MPFL tear

Patella dislocation

What do the following findings suggest? Lucency through upper lateral corner of the patella

Bipartite patella

What do the following findings suggest? Quadricep tendon tear

Patella baja (Unopposed pull of patellar tendon) low patella

What do the following findings suggest? Patella tendon tear

Patella alta (Unopposed pull of Quadricep tendon) high patella

What is associated with patella tendon tear (Patella alta)

SLE

What do the following findings suggest? Fluid superficial to the patella

Prepatellar bursitis

What do the following findings suggest? High T2 signal in Hoffa's fat inferior to patella

Fat impingement syndrome

What do the following findings suggest? High T2 signal Thickening of inferior patella

Jumpers knee

What is the most common fracture site of the tibial plateau?

Lateral

What do the following findings suggest? Talus driven into tibial plafond Comminuted fracture of distal tibia and fibula Articular impaction

Pilon fracture

What do the following findings suggest? Fracture through anterolateral aspect of distal tibial epiphysis

Tillaux fracture (Salter Harris III)

What do the following findings suggest? Vertical component fracture through tibial epiphysis Horizontal component through physis Oblique component through metaphysis

Triplane fracture (SH IV)

What do the following findings suggest? Unstable fracture Medial tibial malleolus fracture Disruption of distal tibiofibular syndesmosis Widened mortis Proximal fibular shaft fracture

Maisonneuve fracture

What do the following findings suggest? Bilateral calcaneal fractures Bohlers angle <20º

Casanova fracture

In a patient with bilateral calcaneal fractures what else needs to be assessed?

Spine T12-L2 for compression/burst fractures

What do the following findings suggest? Fracture of base of 5th metatarsal distal to tuberosity

Jones fracture

What causes an avulsion fracture of the 5th MT?

Lateral cord of plantar aponeurosis or peroneus breves

What do the following findings suggest? Fractures +/- dislocations of medial cuneiform to 2nd MT base on plantar aspect

Lisfranc injury

What forms the achilles tendon?

Gastrocnemius Soleus muscles

The following muscles are found in which aspect of the ankle? Tibialis posterior Flexor digitorum longus Flexor Hallucis longus

Medial

The following muscles are found in which aspect of the ankle? Plantaris Achilles

Posterior

The following muscles are found in which aspect of the ankle? Peroneus longus Peroneus brevis

Lateral

What is the most common location of ligamentous injury in the ankle?

Anterior taolfibular ligament (Inversion)

What do the following findings suggest? Flat foot

Posterior tibial tendon injury

What is the sinus tarsi?

Space between lateral talus and calcaneus

What do the following findings suggest? MRI - obliteration of fat in sinus tarsi space Loss of normal T1 bright fat signal Replacement with scar (Low signal)

Sinus tarsi syndrome

What do the following findings suggest? Thickened plantar aspect fascia >4 mm Heel spurs on XR Bone scan - increased tracer in region of calcaneus Increased T2 signal near insertion of fascia at heel

Plantar fasciitis

What do the following findings suggest? C shaped or boomerang shaped peroneus brevis Central thinning and partial envelopment of peroneus longus

Split peroneus brevis Associated with lateral ligament injury

What do the following findings suggest? Meniscoid mass in lateral gutter of ankle T1 and T2 dark - scar tissue

Anterolateral impingement syndrome (Injury to ATFL & TFL)

What nerve passes through the tarsal tunnel behind medial malleolus?

Posterior tibial nerve

What do the following findings suggest? Soft tissue mass (Tear drop) between 3rd and 4th MT heads Dark on T1 & T2 Projects downward below plantar ligament

Mortons neuroma

Which nerve is affected by Mortons neuroma?

Compression/entrapment of plantar digital nerve within the intermetarsal ligament

What do the following findings suggest? Soft tissue mass between 3rd and 4th MT heads High T2 signal Extends above the transverse ligament

Intermetatarsal bursitis

What do the following findings suggest? Retroachilles bursitis Retrocalcaneal bursitis Thickening of distal achilles tendon Calcaneal bony prominence

Haglunds syndrome

What do the following findings suggest? Collection of fluid around FHL Oedema within Os trigonum Ballet dancer

Os Trigonum syndrome

What do the following findings suggest? Thick achilles tendon >7 mm Unilateral

Achilles tendon tear

What do the following findings suggest? Fluid filled gap at Achilles tendon

Achilles tendon rupture

What do the following findings suggest? Thick achilles tendon >7 mm Bilateral High cholesterol

Achilles tendon xanthoma

What do the following findings suggest? Focal fluid collection on MR between soleus and medial head of gastrocnemius Associated with ACL tear

Planters rupture

What do the following findings suggest? Bony fragment at calcaneum Associated with diabetes

Avulsion of calcaneal tuberosity

What do the following findings suggest? Avulsion of medial plantar process Fragment near medial process of calcaneal tuberosity

Plantar fascia rupture

What do the following findings suggest? Fragment of bone arising at dorsolateral aspect of anterior calcaneus

Extensor digitorum brevis avulsion

What do the following findings suggest? Small linear bone fragment lateral to calcenocuboid joint

Calcaneocuboid ligament avulsion

What do the following findings suggest? Increased lucency of bones

Osteoporosis

What do the following findings suggest? Soft bone due to excessive uncalcified osteoid Diffusely increased lucency of bones Ill defined trabeculae & corticomedullary junction Looser zones

Osteomalacia

What causes osteomalacia?

Vitamin D issues

What do the following findings suggest? Wide lucent bands that traverse at right angles to the cortex Classic in femoral neck & pubic rami

Looser zones (Type of insufficiency fracture)

What causes looser zones?

Osteomalacia Rickets

What do the following findings suggest? Low BMD Thin sharp cortex Prominent trabecular bars Lucent metaphyseal bands Spotty lucencies

Osteoporosis

What do the following findings suggest? BMD T score < 2.5 OR BMD T score -1 to -2.5

<2.5 = Osteoporosis -1 to -2.5 = Osteopenia

What do the following findings suggest? Hx of trauma or infection Severe osteopenia (Thin sharp cortex, increased bone lucency) Preserved joint spaces Most common in hand & shoulder Low bone density, High uptake on bone scan

Reflex sympathetic dystrophy (Sudek)

What do the following findings suggest? Female 3rd trimester of pregnancy - unilateral Male - Bilateral Normal hip joint space Osteopenia (Lucent) MR - Oedema Bone scan - Increased focal uptake

Transient osteoporosis of the hip

What do the following findings suggest? Hx of pain in joint Improves then moves to another joint Osteopenia MR Oedema Self limiting

Regional migratory osteoporosis

What do the following findings suggest? Patchy areas of sclerosis Oedema on STIR (High signal) Dark on T1 Serpiginous dark line Joint effusion

Avascular necrosis

What do the following findings suggest? Patchy areas of sclerosis Oedema on STIR (High signal) Dark on T1 Dark line parallel to suchondral bone Joint effusion

Insufficiency fracture

What do the following findings suggest? Band like fracture line - dark on T1 Variable T2 Normal vertebral body signal +/- retropulsed posterior bone fragments

Osteoporotic compression fracture

What do the following findings suggest? Abnormal marrow signal (Low T1 and T2) Involvement of posterior margin

Neoplastic compression fracture

What is the the normal signal in the vertebral body on T1 and STIR?

T1 bright (Intermediate VB) STIR bright (Bright VB)

What sequences can be used to distinguish a neoplastic fracture from a osteoporotic fracture?

T1 STIR

What is the most common location of an osteochondral defect?

Lateral aspect of medial femoral condyle

What do the following findings suggest? Bone fragment on T2 Usually femoral condyle What is the significance of high T2 signal undercutting the fragment from the bone?

Osteochondral defect High T2 signal suggests an unstable osteochondral defect

What do the following findings suggest? Capitellum of thrower Child <10yrs Entire capitellum Low T1, High T2 No loose body

(Osteonecrosis of capitellum) Panners disease

The following are part of what group of conditions? Kohlers Osgood Schlatters Kienboch Sinding Larsen Johansson

Osteochondroses = Involvement of epiphysis or apophysis which may collapse, sclerose or fragment

What do the following findings suggest? Osteonecrosis of the tarsal/navicular

Kohlers

What do the following findings suggest? 2nd MT head infarction (Flat)

Freiberg infarction

What do the following findings suggest? Thoracic wedging 3 levels Kyphosis >40 degrees

Scheurmann

What do the following findings suggest? Low T1 marrow signal Subcutaneous ulcer High STIR signal in bone adjacent to ulcer

Osteomyelitis

What do the following findings suggest? Paraspinal and epidural inflammation T2 bright disc signal and enhancement Irregular endplate destruction Disc space narrowing T1 dark marrow, T2 bright marrow, post contrast enhancement

Vertebral disc osteomyelitis

What is the most common cause of vertebral disc osteomyelitis?

Staph Aureus

What do the following findings suggest? T1 dark, T2 bright Peripheral enhancement Restricted diffusion Collection between dura and periosteum

Epidural abscess (Posterior) Paraspinal abscess (Anterior)

Where is osteomyelitis in the spine usually found in children?

Isolated discitis

What do the following findings suggest? Tends to spare disc space Skip involvement Large paraspinal abscess Calcified psoas abscess Gibbs deformity - destructive focal kyphosis

Pott disease (Spinal TB)

What do the following findings suggest? Diaphyseal expansile lesion with soft tissue swelling Children Tubular bones of hands and feet

Tuberculous dactylitis

What do the following findings suggest? Joint effusion MR - Synovial enhancement

Septic arthritis

What do the following findings suggest? Gas within the soft tissues Diffuse fascial enhancement

Necrotising fasciitis

What type of bone lesions do the following describe? Ill-defined tiny oval or streak like lucencies Cluster of small lytic holes

Permeative = Ill-defined tiny oval or streak like lucencies Moth eaten = Cluster of small lytic holes

What do the following findings suggest? Most common Young patient 10-20 Aggressive periosteal reaction (Sunburst, lamellated, codman) May have skip lesions

Conventional intramedullary osteosarcoma

What is the imaging pathway for osteosarcoma?

X-ray Bone scan + Chest CT (Identify other bone tumours & Mets) MRI Entire bone Biopsy Chemo + treatment

What is the most likely location of osteosarcoma mets?

Lung - can cause pneumothorax

What do the following findings suggest? Posterior distal femur Metaphyseal location Radiolucent line separating mass from cortex Located in outer layer of periosteum Can have marrow extension

Parosteal osteosarcoma

What do the following findings suggest? Diaphyseal - Medial distal femur No marrow extension Inner layer of periosteum

Periosteal osteosarcoma

What do the following findings suggest? Fluid fluid levels on MRI High T1 signal Cystic lesion within bone Young adult

Telangiectatic osteosarcoma

What are the differentials for a bone lesion with fluid fluid levels?

Telangiectactic osteosarcoma Aneurysmal bone cyst Giant cell tumour

What can cause secondary oestosarcoma?

Pagets disease

What do the following findings suggest? Permeative lesion + Marked sclerosis Diaphysis young Child Soft tissue component, no calcification Lamellated/onion skin periosteal reaction

Ewing Sarcoma

What is the classic location of Ewing sarcoma mets?

Bone*** Lungs

What do the following findings suggest? Age 40-70 Proximal tubular bone - Distal femur Intramedullary or Peripheral Cortical destruction Cortical scalloping Chondroid matrix (Arcs/Rings)

Chondrosarcoma

What do the following findings suggest? Adults 30-60 Can be found in clivus/sarcum T2 very bright Midline Destructive lytic lesion, with expansile soft tissue mass

Chordoma

What is the most common location for a chordoma?

Sacrum

The following are differentials for what? FOG MACHINES Fibrous cortical defect/Fibrous dysplasia Osteoblastoma G: giant cell tumour (GCT) or geode M: metastasis(es)/myeloma A: aneurysmal bone cyst (ABC) C: chondroblastoma or chondromyxoid fibroma H: hyperparathyroidism (brown tumour) I: infection (osteomyelitis) or infarction (bone infarction) or intraosseous lipoma N: non-ossifying fibroma (NOF) E: enchondroma or eosinophilic granuloma (EG) S: simple (unicameral) bone cyst

Lucent bone lesions

The following bone lesions are likely to arise in which part of the bone? ABC Infection GCT Chondroblastoma Clear cell chondrosarcoma

Epiphysis

What do the following findings suggest? Long lesion in long bone Ground glass matrix Lytic lesion with hazy matrix No periosteal reaction or pain

Fibrous dysplasia

What do the following findings suggest? Lytic lesion with hazy matrix NO periosteal reaction or pain Coxa varus angulation

Shepherd Crook deformity - FD in femur

What do the following findings suggest? Polyostotic fibrous dysplasia Cafe au lait spots Precocious puberty

McCune Albright

What do the following findings suggest Polyostotic fibrous dysplasia Soft tissue myxomas Increased risk of osseous malignant transformation

Mazabraud syndrome

What do the following findings suggest? Tibial lesion Mixed lytic and sclerotic lesion - with hazy matrix Potential to be malignant

Adamantinoma

What do the following findings suggest? Children - regresses (Sclerotic) Metaphysis near physis Migrate away from physis with age Eccentric with thin sclerotic border >3cm

Non-ossifying fibroma

What do the following findings suggest? Children - regresses (Sclerotic) Metaphysis near physis Migrate away from physis with age Eccentric with thin sclerotic border <3cm

Fibrous cortical defect

What do the following findings suggest? Multiple non ossifying fibromas Cafe au lait spots Mental retardation Hypogonadism Cardiac malformations

Jaffe Campanacci syndrome

Which syndrome are NOF and FCD associated with?

NF1

What do the following findings suggest? Lesion of medullary cavity with hyaline cartilage 10-30 Humerus/Femur Arcs and rings matrix (Chrondroid) Speckled calcification

Enchondroma

What do the following findings suggest? Lesion of medullary cavity with hyaline cartilage 10-30 Fingers/Toes Lytic/Cystic lesion

Enchondroma

What do the following findings suggest? Lesion of medullary cavity with hyaline cartilage 10-30 Humerus/Femur Arcs and rings matrix (Chrondroid) Speckled calcification Painful >5 cm

Low grade chondrosarcoma

What do the following findings suggest? Multiple enchondromas

Ollier disease

What do the following findings suggest? Multiple enchondromas Haemangiomas - Lucent centered calcifications

Maffucci syndrome

What is the association with Olliers and Maffucci syndromes?

Increased risk of chondrosarcoma

What do the following findings suggest? <30yrs Solitary***/Multiple Vertebra plana Skull with lucent beveled edge lesions Floating tooth - lytic lesion in alveolar ridge

Eosinophilic granuloma

What are the differentials for vertebra plana?

Mets/Myeloma Eosinophilic granuloma Lymphoma Trauma/TB

What do the following findings suggest? Closed physis Lucent lesion + No sclerotic border Abuts articular surface Most common in knee >20yrs Fluid levels on MRI

Giant cell tumour

Can a giant cell tumour metastasise?

Yes to the lung, despite being benign

What do the following findings suggest? 10-25yrs Oval lytic lesion surrounded by dense sclerotic cortical bone Lucent nidus Femoral neck or posterior elements of spine Pain relived by aspirin MR - oedema

Osteoid Osteoma

What is the most common location of osteoid osteoma?

Meta/Diaphysis of long bones Posterior elements of spine (Lumbar***)

What do the following findings suggest? Painful scoliosis Convexity pointed away from lesion

Osteoid osteoma

How are Osteoid osteomas treated?

Percutaneous radio frequency ablation

What do the following findings suggest? >30yrs Oval lytic lesion surrounded by dense sclerotic cortical bone Lucent nidus Femoral neck or posterior elements of spine >2cm MR - oedema

Osteoblastoma

Which lesions can be found in the posterior elements of the spine?

Osteoblastoma ABC Metastases

What do the following findings suggest? Cystic expansile lesion Thin walled, blood filled spaces Fluid-fluid level on MR <30 Tibia - Vertebrae - Femur Septations may enhance

Aneurysmal bone cyst

What do the following findings suggest? <30yrs Tubular bones - humerus/femur/Calcaneum Central location Fallen fragment sign - pathological fracture

Solitary bone cyst

What do the following findings suggest? Lytic or sclerotic lesions Subperiosteal bone resorption - side of finger/clavicle/rib

Brown tumour (Hyperparathyroidism)

What do the following findings suggest? <25yrs Epiphysis of tibia or epiphyseal equivalent Thin sclerotic rim, extension across physeal plate, periostitis Bone marrow/Soft tissue oedema on MR Not T2 bright

Chondroblastoma

The following are what type of bones? Patella Calcaneus Carpal bones Apophyses

Epiphyseal equivalent bones

What do the following findings suggest? <30yrs Osteolytic elongated in shape Eccentrically located Metaphyseal lesion Cortical expansion Proximal metaphyseal region of tibia

Chondromyxoid fibroma

What do the following findings suggest? Calcaneal diaphysis (Anterior 1/3) Fat density on CT/MR or Central fragment within lucent lesion

Intraosseous lipoma

What do the following findings suggest? Variation of normal trabecular pattern Central triangular radiolucent area Anterior 1/3 of calcaneum Persistent thin trabeculae and thin nutrient foramen

Calcaneal pseudo-cyst

What do the following findings suggest? >40yrs Lytic lesion in any bone

Metastases

Which cancers cause sclerotic/blastic mets?

Prostate, Carcinoid, Medulloblastoma

Which cancers cause lytic mets?

Lung Renal Thyroid

What do the following findings suggest? >40yrs Discrete margins Solitary/multiple Vertebral body destruction with sparing of posterior elements Negative bone scan

Multiple myeloma

Which investigation is most sensitive for Multiple myeloma?

MRI

What do the following findings suggest? <40yrs Discrete solitary mass Bone or soft tissue (Extramedullary) Geographic lytic area May have expansile remodelling

Plasmacytoma

What do the following findings suggest? Plasma cell proliferation (Myeloma) Neuropathy Organomegaly Sclerotic mets

POEMS

What do the following findings suggest? Multiple sclerotic lesions centered around a joint Epiphysis Keloid formation

Osteopoikolosis

What do the following findings suggest? Intertrochanteric region of femur lesion Geographic lytic lesion with sclerotic margin How are they managed?

Liposclerosing myxofibroma Followed up due to risk of malignant transformation

What do the following findings suggest? Bone matrix lesion Points away from the joint Bone marrow flows freely into the lesion Normal marrow signal on T1 MR Cartilage cap

Osteochondroma

What do the following findings suggest? Multiple echondondromas

Multiple Hereditary exostosis (Increased risk of malignant transformation)

What do the following findings suggest? Osteochondromas at epiphysis - irregular mass Ankle/Knee Point into the joint Young children

Trevor disease

What do the following findings suggest? Bony spur in the distal humerus Superior to supracondylar canal - medial aspect Points towards the joint

Supracondylar spur

What do the following findings suggest? Saucerisation of adjacent cortex of finger with sclerotic periosteal reaction Lesion in finger

Periosteal Chondroma

What do the following findings suggest? <10 yrs Tibia/Fibula Looks like NOF but centered in anterior tibia Anterior tibial bowing

Osteofibrous dysplasia

What do the following findings suggest? Lucency along back of the posteriomedial aspect of distal femoral metaphysis May be bilateral Scoop like defect, irregular but intact cortex

Distal femoral metaphyseal irregularity (Cortical dermoid) Dont touch lesion

What do the following findings suggest? Calcific deposit in supraspinatus tendon at insertion to greater tuberosity

Calcium hydroxyapatite - Calcific tendinitis

What do the following findings suggest? Linear, parallel and longitudinal lines Metaphysis of long bones

Osteopathia Striata

What do the following findings suggest? Fusiform bone enlargement with sclerosis of long bones Bilateral and symmetric Long bones - tibia Hot on bone scan

Engelmann's disease

What do the following findings suggest? Hair on end skull Expansion of facial bones Expanded ribs Extramedullary haematopoeisis Will obliterate the sinuses Erlenmeyer flask deformity Splenomegaly

Thalassemia

What do the following findings suggest? Hair on end skull Expansion of facial bones Expanded ribs Extramedullary haematopoeisis Will not obliterate the sinuses AVN Mild splenomegaly +/- auto infarction H shaped vertebrae

Sickle cell

What do the following findings suggest? 40-80yrs Wide/expanded bones with thick trabeculae Progression from lytic to sclerotic

Pagets disease

The following are signs of which condition? Blade of grass - lucent leading edge in long bone Picture frame vertebrae - Cortex thickened on all sides Thick skull with frontal aspect falling over facial bones Bowing of tibia

Pagets disease

What is the rugger jersey sign?

Thickened superior and inferior endplates in vertebrae Seen in HyperPTH

What do the following findings suggest? Thickened sclerotic skull involving inner and outer table

Pagets disease

How does Pagets appear in the spine?

Ivory vertebrae - Enlarged sclerotic vertebrae Picture frame - Sclerotic borders with central lysis

What do the following findings suggest? Superior and inferior endplate vertebral sclerosis (Rugger jersey spine) Lateral clavicle reabsorption Paraspinal soft tissue calcifications

Renal osteodystrophy (Osteomalacia + 2ndary Hyperparathyroidism)

What do the following findings suggest? Thick cortical bone Diminished marrow Rugger jersey spine Sandwich vertebrae (Sclerotic lines more well defined) Loss of normal T1 marrow signal, T1 and T2 dark

Osteopetrosis

What do the following findings suggest? H shaped vertebrae - microvascular endplate infarcts Widened disc space

Sickle cell

What do the following findings suggest? Old people Central location (Proximal arms/legs) or thigh Dark-intermediate on T2 Associated with spontaneous haemorrhage

Malignant fibrous histiocystoma/Pleomorphic undifferentiated sarcoma

What do the following findings suggest? Peripheral lower extremities 20-40 Close to joint but doesn't involve the joint Triple sign - high, medium and low signal in the same mass on T2 Bowl of grapes - fluid/fluid levels in mass Painful

Synovial sarcoma

What do the following findings suggest? Peripheral lower extremities 20-40 Close to joint but doesn't involve the joint Soft tissue calcifications + bone erosion

Synovial sarcoma

What do the following findings suggest? Fat signal intensity on all sequences Superficial Fat saturation out No septations

Lipoma

What do the following findings suggest? May have parts that are darker or brighter than fat on T1 Incomplete fat saturation Thick septations

Atypical lipoma/Low grade liposarcoma

What do the following findings suggest? Some elements have fat signal on all sequence Doesn't completely fat saturate or not at all Thick nodular complex septations Enhancing components

High grade liposarcoma

What do the following findings suggest? <20yrs T2 bright T1 dark Not cystic Gadolinium enhancement

Myxoid liposarcoma

What do the following findings suggest? Vertebral body lesion T2 bright Flow voids Intense enhancement Contain fat

Haemangioma

What do the following findings suggest? T2 bright Lower signal than muscle on T1 Soft tissue mass Faint enhancement

Myxoma

What do the following findings suggest? Involves joint synovium and tendon sheath Knee Joint effusion may have marginal erosions Joint space preserved Blooming on GE Low T1 + T2, STIR

PVNS

What do the following findings suggest? Hand (Palmar tendons) Erosions of underlying bone Soft tissue density T1 and T2 dark

Giant cell tumour of tendon sheath

What do the following findings suggest? Hand May have erosions of underlying bone Soft tissue density T1 dark, T2 bright Enhance uniformly

Glomus tumour

What is the following describing? Neoplastic process with formation of multiple cartilaginous nodules in the synovium which progress to loose bodies

Primary synovial chondromatosis

What do the following findings suggest? Affects one joint 40-50s Intrarticular loose bodies - ring and arc calcification (Chondroid) May calcify No blooming artifact on GE No erosions

Primary synovial chondromatosis

What do the following findings suggest? Affects one joint 40-50s Degenerative changes Joint loose bodies - ring and arc calcification (Chondroid) May calcify No blooming artifact on GE

Secondary synovial chondromatosis

What do the following findings suggest? DM patient - T1DM Thigh or calf Marked oedema on MRI Enhancement and irregular regions of muscle necrosis

Diabetic myonecrosis

What do the following findings suggest? Synovial lining Frond like deposition of fatty tissue 50-70s Suprapatellar bursa of knee Associated with trauma/degenerative disease Unilateral T1 and T2 bright, Fat saturation

Lipoma Arborescens

What do the following findings suggest? Frond like hyper echoic mass Joint effusion 50-70s

Lipoma Arborescens

What do the following findings suggest? Big lobular/cystic calcium deposit near joint Fluid-calcium levels on CT No erosion or destruction of the joint Hip, elbow, shoulder GT bursa is most common site

Tumoral calcinosis

What do the following findings suggest? Fine and diffuse soft tissue calcifications Renal and lung calcifications Renal failure (or HighPTH) Elevated calcium

Metastatic calcification

What do the following findings suggest? Circumferential calcifications Lucent center Soft tissue lesion Oedema & enhancement on MRI

Myositis ossificans

What do the following findings suggest? Sclerosis Asymmetric Joint space narrowing Subchondral cysts Osteophyte formation

Osteoarthritis

What do the following findings suggest? Deformity Debris Dislocation Dense subchondral bone Destruction of articular cortex

Neuropathic joint

If you have a neuropathic joint, what investigations should be next?

MRI spine ?Syrinx or spinal cord injury

What do the following findings suggest? Diabetic Foot abnormality - Midfoot Deformity Debris Dislocation Dense subchondral bone Destruction of articular cortex

Charcot foot

What is a rocker bottom foot?

Collapse of the longitudinal arch from diabetic neuropathy

What do the following findings suggest? Gull wing deformity Central erosions Postmenopausal women Favours DIP joints

Erosive OA

What do the following findings suggest? Soft tissue swelling Osteoporosis Uniform joint space narrowing Marginal erosions Bilateral & Symmetric Spares DIP joints Proximal

Rheumatoid arthritis

Which location is usually the first affected in RA of the foot?

5th MT head

What is the progression of disease in RA of the hands?

MCP joints first PIP joints 1st CMC spared normally

How can RA of the hand be distinguished from OA?

OA usually involves the 1st CMC RA Spares the 1st CMC

What do the following findings suggest? RA >10 yrs Splenomegaly Neutropenia

Felty syndrome

What do the following findings suggest? RA Pneumoconiosis

Caplan syndrome

In RA of the hip what is the classic distribution? What is this in OA?

OA = Superolateral RA = Medial

What do the following findings suggest? Erosive change with bone proliferation (Periostitis) Favours IP joints (Distal) Erosions at margins of joint, then progress to central Dactylitis Asymmetric

Psoriasis

The following are findings in which condition? Acro-osteolysis Pencil in cup deformity Ankylosis in finger Ivory phalanx - sclerosis and/or bone proliferation

Psoriatic arthritis

What do the following findings suggest? Severe bone resorption leading to soft tissue telescoping collapse

Arthritis Mutilans

What do the following findings suggest? Bone proliferation Erosions Asymmetric SIJ involvement Affects feet more Urethritis + Conjunctivitis + Arthritis

Reactive arthritis

What do the following findings suggest? Bamboo spine - syndesmophwytes flow from adjacent vertebral bodies Shiny corners Symmetric SIJ involvement (1st)

Ankylosing spondylitis

What do the following findings suggest? Axial arthritis - SIJ and spine Peripheral arthritis IBD

Enteropathic arthritis

Which conditions affect the unilateral SIJ?

Infection

Which conditions affect the SIJ asymmetrically?

Psoriasis Reactive arthritis

Which conditions affect the SIJ symmetrically?

Inflammatory bowel Enteropathy Ankylosing spondylitis

What do the following findings suggest? Male >40 Big toe Joint effusion Spares joint space until late disease Juxta-articular erosions Punched out lytic lesions Overhanding edges Soft tissue tophi

Gout

What do the following findings suggest? Juxta-articular soft tissue mass low on T2 Enhancing tophi

Gout

Which conditions have a similar appearance to gout?

Amyloid RA (Cystic) Reticular histiocytosis Sarcoid Hyperlipidemia

What do the following findings suggest? Old people Favours TFCC Most common at knee Hooked MCP osteophytes with chonedrocalcinosis OA features Atypical joint distribution

CPPD (Calcium pyrophosphate dihydrate disease)

What do the following findings suggest? MCP joints Hooked osteophytes Uniform joint space loss at all MCP joints

Haemochromatosis

What do the following findings suggest? Shoulder Advanced articular and bone destruction Hx of trauma

Milwaukee shoulder - due to hydroxapatite deposition

What do the following findings suggest? Subperiosteal bone resorption of radial aspect of 2nd and 3rd fingers Rugger jersey spine Terminal tuft erosions Brown tumours

Hyperprathyroidism

What is the other way of describing hyperparathyroidism?

Phosphate retention

What do the following findings suggest? Diffuse paravertebral ossifications Ossification of ALL >4 levels Sparing of disc spaces No SIJ involvement

DISH

What do the following findings suggest? Focal lateral paravertebral ossification Ossification of annulus fibrosis

Psoriatic arthritis

What do the following findings suggest? Reducible deformity of joint without articular erosions Ulnar subluxation of MCPs Increased risk of patellar dislocation

SLE

What do the following findings suggest? Non-erosive arthropathy with ulnar deviation of 2nd to 5th fingers at MCP Post rheumatic fever

Jaccoud's arthropathy

What do the following findings suggest? <16yrs Proximal distribution of destruction Premature fusion of growth plates - ankylosis Enlarged epiphysis in knee and widened intercondylar notch

Juvenile idiopathic arthritis

What do the following findings suggest? Bilateral involvement of shoulders, hips, carpals and knees Joint space preserved Associated with dialysis

Amyloid arthropathy

What do the following findings suggest? Widened of joint space in adult hip Early onset OA Widening of osseous structures

Acromegaly

Where is red marrow normally found in adults?

Humeral head Femoral head

How does marrow appear on MR?

Yellow marrow = Bright on T1 Red marrow = Isointense to muscle on T1 (Darker) but not darker than disc

What is the normal pattern of marrow conversion?

Epipysis converts fatty marrow after ossification Diaphysis then metaphysis

What is the normal pattern of marrow re-conversion?

Axial skeleton to peripheral

What do the following findings suggest? Marrow darker than muscle on T1 STIR marrow may be brighter than muscle T2 variable Lucent metaphyseal band (Child)

Leukemia (Leukemia cells replace red marrow)

What do the following findings suggest? Destructive mass in bone of leukaemia patient

Chloroma (Granulocytic sarcoma)

What is the best sequence to demonstrate a NOF Fracture?

Coronal T1

What is the best sequence to demonstrate osteomyelitis?

T1 non fat sat STIR

What do the following findings suggest? Soft tissue calcifications (IM/SC) T2/STIR high signal due to muscle oedema If chronic, fatty infiltration of muscle/calcifications

Polymyositis/Dermatomyositis

What do the following findings suggest? IVD calcifications at every level with disc space narrowing

Ochronosis (Alkaptonuria)

What do the following findings suggest? Seen in lower limb in single sclerotome Thickened, irregular wavy cortex of long bone Intense uptake on bone scan

Melorheostosis

What do the following findings suggest? Bone marrow signal - T1 high T2 intermediate

Normal bone marrow

What do the following findings suggest? Bone marrow signal Low T1 signal High T2 signal

Abnormal bone (Metastases, myeloma, regeneration)

What do the following findings suggest? Bone marrow signal T1 low signal T2 low signal

Blastic metastases (Prostate, breast, TCC, myelofibrosis)

What do the following findings suggest? - valgus stress to flexed and externally rotated knee - posterolateral tibial plateau and mid part of lateral femoral condyle

Pivot shift injury ACL Tear

What do the following findings suggest? anterior force to tibia in a flexed knee (e.g. knees against dashboard in motor vehicle collision, or fall onto flexed knee) contusion pattern: anterior tibia +/- posterior patella

Dashboard injury PCL Injury

What do the following findings suggest? - valgus stress to flexed knee - contusion pattern: lateral femoral condyle and lateral tibial plateau +/- medial femoral condyle from medial collateral ligament (MCL) avulsive stress

Clip injury MCL Injury

What do the following findings suggest? - direct force to anterior tibia with foot planted - contusion pattern: "kissing contusions" of anterior tibial plateau and anterior femoral condyle

Hyperextension injury associated with ACL, PCL, meniscal injuries, and in severe cases knee dislocation

What do the following findings suggest? - twisting injury to flexed knee - contusion pattern: anterolateral lateral femoral condyle and inferomedial patella

Lateral patellar dislocation

What do the following findings suggest? MRI - left anterolateral thigh showed a well-defined crescentic collection extending along superficial fascia overlying the muscle plane, appearing hypointense with hyperintense (fat) strands T1 images and hyperintense on T2 CT - fluid-fluid level resulting from sedimentation of blood components and may or may not contain a capsule surrounding the lesion

Morell Lavellee lesion

The following is the position used to image on US which muscle? Patient position: the arm is in a neutral position, elbow flexed 90°, forearm supinated (palm up).

Biceps

The following is the position used to image on US which muscle? the arm is in a neutral position, elbow flexed 90°, forearm supinated (palm up). Patient position: the arm is kept in the same position as above and is externally rotated

Subscapularis

The following is the position used to image on US which muscle? Patient position: shoulder internally rotated and extended ("reaching to get wallet from back pocket" or "scratching between shoulder blades" positions).

Supraspinatus

The following is the position used to image on US which muscle? Patient position: the patient reaches across their chest and holds the contralateral shoulder with their hand.

Infraspinatus

Which imaging is best for assessing the synovium?

T1 weighted images before and after intravenous contrast - T2 weighted fat saturated - STIR in 2 planes

What does the following describe: Focal neurological deficit Bilateral symmetric metaphyseal and diaphyseal sclerosis, but sparing of epiphysis Cystic lung disease Hair kidney

Erdheim Chester disease (Lipid laden histiocytes)

What is the following describing? Wrist instability Capitolunate angle increased Scapholunate angle decreased Lunate tilts volar

Lunotriquetral ligament injury

What do the following findings suggest? Polyarticular Male Widened intercondylar notch Blooming artifact into joint Squared patella, enlarged epiphysis, juxta-articular osteoporosis

Haemophillic arthropathy

What do the following findings suggest? Absent antero-superior labrum Thickened middle GH Ligament, originates from superior labrum adjacent to bicipital labral complex

Buford complex (Normal variant)

What do the following findings suggest? Multiple osteochondromas and enchondromas

Metachondromatosis

The following cause erosions where? Erosive OA

Central erosions

The following cause erosions where? RA Psoriasis Reactive arthritis

Marginal erosions

The following condition causes erosions where? Gout

Juxta-articular erosions

What do the following findings suggest? Oligo/Polyarticular Lace like bony resorption of phalanges Multiple cystic lucencies S/C soft tissue masses No joint space narrowing

MSK Sarcoid - CXR to confirm

What do the following findings suggest? Acro-osteolysis Bone resorption + Osteopenia Soft tissue calcification Sclerodactyly Patulous oesophagus

Scleroderma

What do the following findings suggest? Linear bilateral smooth symmetrical periosteal reaction What is the next investigation?

Hypertrophic osteoarthropathy (HOA) CXR to rule out lung cancer

Which malignancies cause expansile lytic mets?

Thyroid Kidney

What are the causes of acro-osteolysis? PINCH FO

PINCH FO P:psoriasis/pyknodysostosis/progeria I: injury, e.g. thermal burn, frost bite N: neuropathy, e.g. diabetes mellitus, leprosy C: collagen vascular disease, e.g. scleroderma, Raynaud disease H: hyperparathyroidism F: familial, e.g. Hajdu-Cheney syndrome O: other, e.g. polyvinyl chloride exposure

What do the following findings suggest? Short femur, short humerus Champagne glass pelvis Large heads, trident hands, Narrowing of interpedicular distance

Achondroplasia

Which MRI sequence is best to assess the cartilage?

T2/PD

What is the most common location of a giant cell tumour?

Distal lateral femur/Proximal tibia

What is the target for a shoulder arthrogram?

Superior medial target

What is the target for hip arthrogram?

Lateral head/neck target

The following cause which change in the clavicle? Myeloma hyperparathyroidism metastases cleidocranial dysplasia Gorlin basal cell nevus syndrome

Lateral clavicle absent

The following cause which change in the clavicle? metastases infection lymphoma eosinophilic granuloma rheumatoid arthritis sarcoma

Medial clavicle absent

The following ligaments are found in which compartment of the ankle? ATFL PTFL CFL Which is most commonly torn?

Lateral ATFL is most commonly torn

The following ligaments are found in which compartment of the ankle? Deep deltoid Superficial deltoid Spring (Calcaneonavicular)

Medial

What is the following describing? Lateral displacement of 2nd MT base on AP view Dorsal step off sign on Lateral view >2 mm between 1st and 2nd MT

Lisfranc injury

What is the following describing? Bowing of the radial shaft with increased interosseous space and dorsal subluxation of the distal RU joint. Due to premature closure or defective development of the ulnar 1/3 of the distal physis of the radius Related to Turner syndrome, Achondroplasia, Hurler

Madelung deformity

What is the following describing? Most common type of soft tissue sarcoma Associated with radiotherapy, paget disease Usually affects extremities

Undifferentiated Pleomorphic sarcoma

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