MSK Flashcards
(91 cards)
1
Q
O’Donohoghue’s triad
A
- ACL
- MCL
- Medial meniscus
2
Q
Adamantinoma
A
- Sharply circumscrobed lucent lesion with sclerotic border - can be loculated.
- Almost exclusively in the tibia - mid diaphysis
- Has malignant potential.
3
Q
Aneurysmal Bone Cyst
A
- < 30 yo
- Often present with pain.
- Well defined, eccentric, expansile and lytic - rapid progression
- Fluid/fluid level on X-sectional
- Can occur anywhere.
4
Q
Ankylosing Spondylitis
A
20 yo m
Typically statrs with symmetric envolvement of the SI joints
Contigious thoraco lumbar involvement
- Syndesmophytes
- Bamboo spine
- Shiny corners of plain film
- Romaus lesions - T2 bright anterior sup and inf end-plates
- Ossification of interspinous and supraspinous ligaments
Assoc w/
- IBD
- Iritis
- Aortitis
- Upper lobe pulmonary fibrosis
5
Q
Bennets fracture
A
Intra-articular MCP fractures of the thumb metacarpal.
Dorsal and radial dislocation (APL force)
6
Q
Brown Tumour
A
- Due to hyperparathyroidism
- Can have any appearance. - sclerotic when HPT treated.
- Assoc with subperiosteal bone resorption of HPT:
- Radial aspect of phalanges
- Clavicle
- medial proximal tibia
- SI joints
- Frayed and ragged physes.
- Renal osteodytrophy as a cause - Osteoporosis/sclerois.
7
Q
C-spine acceptable soft tissue measurements
A
Predental space = 3mm adult, 5mm children
Nasopharyngeal space (anterior to C1) = 10mm
Retropahryngeal space (C2-C4) = 5-7 mm
Retrotrcheal space (C5-C7) = 22mm
8
Q
Calcium Hydroxyapatite Deposition Disease. (HADD)
A
- Periarticular CHA deposition - inflammation without structural joint abnormalities.
- Most common sites:
- insertion of suprspinatous
- FCU
- Milwaukee shoulder = rotator cuff and subacromial bursa.
- MCPs and IPJs
- Longus coli
- Glut max
9
Q
Caplan synfrome
A
pneumoconiosis, rheumatoid lung nodules and RA
10
Q
Charcot Joint
A
- Joint destruction
- Dislocation
- Heterotopic new bone formation
Most typically seen in diabetics in the 1st and 2nd tarsometarsal joints
11
Q
Chauffeur’s fracture
A
Intrarticular fracture of the radial styloid
12
Q
Chondroblastoma
A
- Young
- Epiphyseal lobulated lucent epiphyseal lesion with calcification
- Long bones
- Tx with curettage
- MRI:
- prominent priosteal reaction
- bone marrow oedema
- soft tissue oedema
13
Q
Chondromyxoid Fibroma
A
- Any age
- metaphyseal lobulated fibrous lucent lesion.
- Resemble NOF but more readily extend to the epiphyses.
- Chondroid matrix.
14
Q
Chondrosarcoma
A
- >40
- painful long bone lesion
- resemble enchondromas but can have periostitis and destruction.
- Causes end osteal scalloping.
- Soft tissue involvement with amorphous calcification.
15
Q
Clay shovelers fracture
A
- C6 or C7 spinous process avulsion fracture.
- Caused by supraspinous ligament stress.
16
Q
Desmoid Tumour
A
- Start in soft tissues.
- Slow growing
- Well defined, multiloculated destructive bone lesion. ‘geographic pattern’
17
Q
DISH (Diffuse idiopathic skelteal hyperostosis)
A
AKA Forestier’s disease
Bulky flowing osteophytes over atleast 4 vertebral bodies. (Commonly thoracic)
Associated ligamentous and tendonous ossification. - ANTERIOR LONGITUDINAL
No SI joint involvement.
18
Q
Dorsal Intercalated Segment Instability (DISI)
A
- Dorsal tilt of lunate
- Capitolunate and scapholunate both increase.
19
Q
Elastofibroma
A
>55 yo women
Pseudotumour of the posterior chest wall at the onferomedial border of the scapula.
From chronic irritation.
20
Q
Enchondroma
A
- Typically calcified chondroid matrix except in phalanges.
- Endosteal scalloping
- No periostitis
- Multiple enchondromas Olliers Disease. With soft tissue haemangiomas Maffucci Syndrome.
21
Q
Eosinophillic granuloma
A
- Anysort of appearance.
- Periostitis is thick, uniform and wavy (benign) - Can also be laminated like Ewing sarcoma.
- Can have a bony sequestrum.
- Almost eclusively in UNDER 30’s.
Form on Histocytosis X, Letterer-Siwe disease and Hand-Schuller-Christian disease.
22
Q
Erdheim-Chester Disease
A
- 55 yo
- Multisystem granulomatosis
- inflitration of histocytes causing painful scleroitic lesions of the appendicular skeleton.
- Present with bone pain, diabetes insipidus, neurological signs, retroperitoneal fibrosis and and exopthalmos.
23
Q
Essex-Lopresti
A
Radial head fracture with distal radio-ulnar dislocation
24
Q
Ewings
A
- <10
- Perimiative lesion in the diaphyisis of a kid
- periostitis - Onion skin or sunburst/amorphus
- Mets to lung
25
Features of rheumatoid arthritis
* soft tissue swelling
* osteoporosis
* joint space narrowing
* marginal erosions
26
Features of staphylococcus discitis
No calcification Posterior elements spared Acute onset One level
27
Features of tuberculous discitis
* Calcification
* Posterior element involvement
* Insidious onset
* Gibbus deformity (angular kyphosis)
* Multiple levels
28
Fibrous dysplasia
* Can be mono or polyostotic (pelvis and ipsilateral femur)
* Long lesion in long bone.
* Ground glass/ smokey matrix.
* DDx McCune Albright syndrome and Adamantinima
29
Flexion Teardrop Fracture.
Disruption of the posterior elements causing anterior compression fracture. Cord comprimise due to retropulsion of posterior elelments.
30
Galeazzi fracture
Radial fracture with distal radioulnar dislocation
31
Gamekeeper's thumb
* Avulsion fracture at the base of the thumb proximal phalanx where the ulnar collateral ligament inserts.
* Caused by ski pole being jammed in the 1st web space.
32
Giant Cell Tumour
* Adults
* Exclusively at the end of long or flat bones.
* **Must** have closed physes
* Must abut the articular surface.
* Well defined without a scerotic border.
15% have malignant potential. Can metastesise to lung.
Tx: Pack and curettage. Monitor for recurrence.
33
Glomus tumour
Benign vascular tumour
Well circumcribed, lytic and painful
Terminal phalangeal location.
34
Gout
* Uric acid postively birefringent crystals under polarised microscopy
* Well defined 'marginal'/periarticular erosions - with sclerotic borders
* Soft tissue nodules - tophi
* Random distribution - 1st MTP most common (podagra)
* Without marked osteoporosis
* Joint space preserved
35
Haemochromatosis
* Iron deposistion leading to fibrosis and eventual organ failure.
* Causes degenerative joint disease which typically affects the 2nd-4th MCPJs.
36
Haemochromotosis arthropathy
Same distribution as CPPD
Distinctive features:
* Hook-like osteophytes on MCP heads (fourth and fifth)
* Generalized osteoporosis
37
Hangman's Fracture
* Unstable fracture of posterior elements of C2 with anterolithesis on C3.
* Caused by hyperextention and distraction ( Dashboard )
38
Homocystinuria
AR
* Lens dislocation
* seizures
* dystonia
* developmental delay
* scoliosis
* pectus
* thromboembolism
* spontaneous pneumothorax
39
Intraosseous haemangioma
Middle aged
Vertebral body \> Skull \> Face
Characteristic corduroy appearance with vertical trabecular pattern of verterbral bodies. Lucent, slightly expansile intraosseous lesion.
Usually asymptomatic unless fractured or causing cord compression.
40
Intraosseous lipoma
Prox femur, fibula and calcaneous.
lucent but may have a calcified nidus.
41
Jaffe Campanacci Syndrome
Multiple non-ossifying fibromas, café-au-lait spots, hypogonadism, cryptorchism, mental retardation, and ocular and cardiovascular abnormalities.
42
Keinbock malacia
Avascular necrosis of the lunate resulting in a negative ulnar variance.
43
Kohler disease
Idiopathic avascular necrosis of the navicular in 4-6 year olds.
In adults it is known as **Mueller Weiss Syndrome**
44
Kummel Disease
* When an acute anterior wedge fracture is left untreated.
* After 1-2 weeks can result in further compression and paraplegia.
45
Lipoma Arborecens
Diffuse fatty infiltration of the knee synovium
Painless swelling of the knee
Fatty frond like projections in to the synovium on MR
46
Lovers fracture
Calcaneal fracture
47
Lytic mets
Most common:
* Kidney
* Lung
* Thyroid
* Breast
48
Maffucci's Syndrome
* Multiple enchondromas
* Associated with soft tissue haemangiomas
* calcified phleboliths
49
Malignant Fibrous Histocytoma
* 40 yo
* Lytic lesion - no ostioid or chondroid matrix
* moth eaten fairly well defined areas of lysis
* Can have bony sequestrum.
50
Mallet finger
* Avulsion fracture at the base of the distal phalanx where the externsor digitorum inserts.
* Results in unopposed flexion.
51
Mastocytosis
Mast cell infiltration of bone marrow, skin and other organs.
Bones: Osteosclerosis / osteoporosis
GI stuff = hepatosplenomegaly, jejunal thickeing, lymphadenopathy and ascites.
Chest = Skin changes, fibrosis and pulmonary nodules.
52
Mazabraud syndrome
Multiple soft tissue myxoma and fibrous dysplasia
53
McCune Albright Syndrome
* Polyostotic fibrous dysplasia
* Cafe au lait spots
* Precocious puberty
54
Monteggia fracture
Ulnar fracture with proximal radio-ulnar dislocation
55
Morel-Lavallee lesion
Degloving injury of the proximal lateral thigh when SC tissue decome detached from muscle/fascia.
56
Myelofibrosis
Marrow replaced by fibrosis. = Diffuse patchy osteosclerosis
Massive extramedullary haematopoiesis - hepatosplenomegaly and paraspinal masses.
57
Non-Ossifying Fibroma
* \< 30yo
* \<2cm is known as a fibrous cortical defect.
* Not pain. No periostits.
* Typically cortically based in the metaphysis of long bones.
* Thin sclerotic border with scalopping and slightly expansile.
Mx: watch and wait - result in spontaneous regression. Can be sclerotic when regressing and appear as hot on BS due to increased osteoblastic activity.
58
Ochronosis
AR. Homgentistic acid deposition in hylane cartilage causes black/brown pigmentation.
* Multilevel intervertbral disc calcification
* cartilage, tendons and ligaments
* Osteoporosis
* OA of SI joints and peripheral joints
59
Olliers disease
Muliple hand and feet enchondroma
25% chance of malignant transformation to chondrosarcoma
60
Osteoblastoma
* Expansile scerotic lesion.
* 50% contain speckled calcification.
* Commonly occur in the posterior elements of vertebral bodies.
DDx: ABCs
61
Osteochondroma
* Bony metaphyseal projection with a cartilage cap. Points away from the joint.
* Benign and resolves by adulthood.
* Operate is complications of mass occur.
* assoc. w/ Multiple heriditary exostoses
* Trevor disease (Displasia epiphysealis hemimelica)
* intra-articular osteochondroma (knee + ankle most common)
62
Osteosarcoma
* \<30 yo
* Secondary (Pagets old)\> Medullary \> Periosteal \> Parosteal - interms of lethality.
* Ostioid mattix - mixed sclerotic.
* Teilangectatic can be entirely lytic.
* Parosteal prefers the posterior metaphysis of long bones.
* Mets to lung and bone
63
Ostioid Osteoma
* Small benign tumours but which can be quite symptomatic.
* Pain relieved by aspirin
* Imaging:
* \<2cm cortically based. with a nidus.
* Diaphyses of long bones but the posterior elements of the spine
* MRI shows extensive bone marroy oedema
64
Parsonage-Turner syndrome
Acute brachial neuritis - commonly affects suprascapular (+/- axillary nerve)
Causes oedema and then atrophy of supraspinatous and infraspinatous. (+/- deltoid)
65
Pigmented Villonodular Synovitis
10-50
Diffuse and focal forms
Knee \> hip \> elbow \> ankle.
Synovium thickened and replaced by fibrous masses that erode the bone and can redcued joint space late in disease
MR T1 and T2 low masses emanating from the synovium.
66
Pilon fracture
Intrarticular distal tibial fracture
67
Pitt's Pit
Well defined oval lucent lesion in the femoral neck.
Reflects a herniation of the synovioum and soft tissues into the bone cortex.
68
Poems syndrome
Japanese person with **_P_**olyneuropathy, **_O_**rganomegaly, **_E_**ndocrinopathy, **_M_**-protein (sclerotic multiplemyeloma), **_S_**kin hyperpigmentation
69
Psoriatic arthritis
Seronegative spondyloarthropathy
Types:
* Asymmetric oligoarthropathy
* Spondyloarthropathy of SI joints and spine - asymmetric
* Symmetric polyarthropathy (like RA)
Hand:
* Sausage digit
* Ivory phalanx
* Tuft resorption
* Mouse ears
* Pencil-in-cup
* **_Periostitis_**
70
Pyknodysostosis
Brittle boned dwarf with wormian bones, small straight jaw and no short fingers.
* Dwarfism
* Micrognathia
* Straight mandible
* Dense fragile bones
* Acroosteolyisis
* Wormian bones
* Undereveloped paranasal sinuses and mastoid aircells
71
Reactive arthritis
Post non-gonococcal urethritis or bacillary dysentry
* Shigella, Yersinia, Salmonella, Campylobacter and Chlamydia
* Classic triad = Urethritis, conjuctivitis and arthritis
Radiographic features:
* MTP erosions
* Retrocalcaneal bursitis
* Achilles and plantar enthesopathy
* Asymmetric sacroiliitis
* Thoracolumbar osteophytes with skips
* Periostitis and pencil in cup deformity
72
Rheumatoid Arthritis
* Periarticular swelling
* Periarticular osteoperosis (symmetrical)
* Marginal bone erosions (capsular insertion)
* Erosion of the ulnar styloid and triquetrum are classic
* Subluxation and fibrous ankylosis (late)
* Generalised disuse osteopaenia.
73
Rolando
Comminuted Bennets
74
SAPHO syndrome
**_S_**ynovitis, **_A_**cne, **_P**_ustulosis, _**H_**yperostosis, and **_O_**steitis
* osteitis of the anterior chest wall
* hyperostosis and soft tissue calcification between the **medial clavicle, sternal manubrium, and anterior upper ribs.**
75
Scapholunate advanced collapse (SLAC)
* Chronic scapholunate dissociation and chronic scaphoid non-union.
* CPPD most common cause
* Capitate subluxates dorsally on the lunate. ---\>becomes a DISI.
76
Scelrotic Mets
Most common:
* Prostate
* Breast
Other rarer:
* Hodgkin lymphoma
* Carcinoid
* Neuroblastoma
* TCC
77
Scleroderma
Soft tissue calcification
Acroosteolyisis
Soft tissue atrophy
Erosive changes of DIP and PIP
78
Sclerotic mets
1. Prostate
2. Breast (Mixed)
3. TCC
4. Lymphoma
5. Mucinous Adenocarcinoma
6. Medulloblastoma
7. Neuroblastoma
8. Carcinoid
79
Segond fracture
Avulsion fracture of the lateral tibial condyle - assoc w/ ACL injury
80
SLE
Reversibly ulnar deviation of the metacarpals.
Bilateral and symmetric
Non-erossive
Tenosynovitis of flexor tendons
DDx Jaccouds arthropathy
81
Solitary Bone Cyst.
* \< 30 yo
* Centrally based.
* Typically starts at the physes of long bones and extends into the metaphysis.
* Painless. But present usually after a fracture. (Fallen fragment sign).
82
Spondylolysis
* Break or defect in pars interarticularis portion of the lamina.
* If bilateral can cause spondylolisthesis.
83
Sudeck Atrophy
* after minor trauma to extremity resulting in pain and swelling.
* causes severe patchy osteoporosis.
84
Superior labral tear from anterior to posterior (SLAP)
Type I: fraying or tear of the superior labrum
Type II: detachment of the labral-bicipital complex from the superior glenoid
Type III: bucket-handle tear of the superior labrum
Type IV: bucket-handle tear with extension into the biceps tendon
85
Synovial cell sarcoma
15-35 yo in the knee.
MR triple sign = T2 intensities for hemorrhage, necrosis, solid tissue, and calcification. aka Bowl of grapes sign.
86
The Osteochondroses
* Scheuermann disease = Spine
* Panners = capitellum
* Blount disease = Tibial epiphysis
* Osgood-Schlatter disease = Tibial Tubercle
* Sindig-Larsen-Johansson disease = Proximal patella tendon
* Keinbock disease = Lunate
* Kohlers = Tarsal navicular
* Sever disease = Calcaneus
* Freiberg infarction = 2nd Metartarsals
* Perthes disease
87
Tillaux fracture
Salter-Harris III through the lateral distal tibial epiphysis (older kids - medial physis is closing)
88
Triplane
Salter-Harris 3/4 of the distal tibia
89
Volar intercalated Segment Instability (VISI)
* Volar tilt of lunate.
* Increased capitolunate angle.
* Scapholunate angle sometimes decreased.
90
Which lesions contain a bony sequestrum?
1. Infection
2. Eosinophillic Granuloma
3. Lymphoma
4. Fibrosarcoma
5. Ostioid osteoma (Mimic)
91
Wilsons disease
AR disease causing copper accumulation in basal ganglia, liver, joints etc...
Same distribution as CPPD
Distinctive features:
* Subchondral fragmentation
* Generalized osteoporosis
