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Flashcards in MSK Deck (242):
1

How fast do phalanges heal?

quickly. 3 weeks

2

How fast does the tibia heal?

slowly. 10 weeks

3

How fast do bones typically heal?

6-8 weeks

4

What does AVN look like on T1

dark

5

What band is most important in scapho lunate ligament?

dorsal

6

What is considered widening of scapho lunate space?

>3mm

7

What ligament disruption and fracture is associated with mid carpal dislocation?

triquetrial fracture

triquetro lunate ligament

8

lunate dislocation occurs with what ligament injury?

dorsal radiolunate ligament

9

DISI injury

radial sided, SL ligament injury

10

VISI injury

LT ligament

11

normal scaphoid lunate angle?

30-60 angle

12

DISI angle

> 60

13

VISI angle

<30

14

Two fractures at the base of the first metacarpal?

bennett and rolando

15

THe pull of what tendon causes dorsolateral dislocation in Bennett Fracture?

abductor pollicis longus

16

What is gamekeepers thumb?

avulsion at base of proximal first phalanx with ulnar collateral ligament disruption

17

What is a Stener Lesion?

adductor tendon gets caught in torn edges of UCL (in gamekeepers thumb)

18

yoyo appearance on MRI

stener lesion

19

Carpal tunnel syndrome is associated with what four things?

dialysis, pregnancy, DM, hypothyroidism

20

Guyons canal is formed by what bones?

pisiform and hamate

21

What gets entrapped in guyons canal?

ulnar nerve

22

What is handle bar palsy?

ulnar nerve entrapment in guyon canal

23

Colles fracture

dorsal angulation

24

Smith fracture

volar angulation

25

What is a barton fracture?

radial rim fracture with radial carpal dislocation

26

How do you know a lateral wrist radiograph is true?

volar cortex of pisiform overlies central 1/3 of interval between scaphoid and capitate

27

Which tendon is associated with the TFCC?

extensor carpi ulnaris/compartment 6

28

Injury where in the TFCC is good?

peripheral

29

Fracture of what is associated with posterior dislocation of the elbow?

capitellum

30

What is Essex Lopressi fracture?

fracture or radial head and anterior dislocation of DRUJ

31

What is osbornes ligament?

epicondylo olecranon ligament, covering cubital tunnel

32

Cubital tunnel syndrome can be secondary to what acessory muscle?

anconeus

33

What is the rim sign?

no overlap of glenoid and humeral head due to posterior dislocation

34

What is the trough sign?

reverse hill sachs due to impaction on anterior humerus in posterior dislocation

35

What are the 4 main types of shoulder prosthesis?

humeral head resurfacing, hemi arthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty

36

Glenoid and cuff intact

resurfacing or hemi

37

glenoid intact, cuff deficient

hemi or reverse

38

glenoid deficient, cuff intact

TSA

39

glenoid and cuff deficient

reverse

40

What is the most common complication of total shoulder?

loosening of the glenoid component

41

What is the anterior escape complication in total shoulder?

anterior migration of humeral head after subscap failure

42

What is a reverse shoulder complication

posterior acromion fracture due to deltoid tugging

43

ASIS avulsion

sartorius

44

AIIS avulsion

rectus femoris

45

Pubic symphysis avulsion

adductor

46

ischial tuberosity avulsion

hamstrings

47

lesser trochanter avulsion

illiopsoas

48

greater trochanter avulsion

gluteus medius and minimus

49

What are three types of snapping hip syndrome?

extrenal internal intra articular

50

What is the most common type of snapping hip syndrome?

external. IT band over greater trochanter

51

What is internal snapping hip syndrome?

illiopsoas over illiopectineal eminence or femoral head

52

What is the intra articular snapping hip syndrome?

labral tears or joint bodies

53

What age is CAM FAI seen in?

young males

54

What is a segond fracture?

lateral tibial plateau a/w ACL tear, occurs with interal rotation

55

What is a reverse segond fracture?

medial tibial plateau fracture a/w pcl tear due to external rotation. also medial meniscus injury

56

What is arcuate sign?

avulsion of proximal fibula, associated with PCL tear

57

What is the deep intercondylar notch sign?

depressed lateral femoral condyle a/w acl tear

58

What ist he classic association with patella alta?

SLE

59

bilateral patellar rupture=

chronic steroids

60

What ist he most common type of tibial plateua fracture?

type 2 split and depressed lateral plateau

61

What is a pilon fracture?

tibial plafond fracture

62

What is a tillaux fracture?

salter harris type 3 through tibial epiphysis

63

What is a triplane fracture?

salter harris 4

64

Maisonneuve fracture?

medial malleolus and proximal fibular fx

65

What is the casanova fracture?

bilateral calcaneal w/ spine fracture

66

Bohlers angle less than what is concerning for fracture?

20 degrees

67

Where is a Jones fracture?

base of fifth metatarsal, 1.5cm from tuberosity

68

What is fifth metatarsal avulsion fracture due to?

tug from lateral cord of plantar aponeurosis or peroneus brevis

69

What is the most common dislocation of the foot?

lisfranc

70

What is the fleck sign?

osseous fragment in lisfranc space a/w LF ligament disruption

71

Two diseases with looser zones?

rickets and osteomalacia

72

T score is what?

relative to young adults

73

Osteopenia =

-1 to -2.5

74

Reflex sympathetic dystrophy is also called what?

complex regional pain syndrome or sudeck atrophy

75

looks like unilateral RA with preserved joint spaces?

RSD

76

Transient osteoporosis of the hip is most common in what type of patient?

pregnant third trimester

77

joint pain that improves, but then migrates?

regional migratory osteoporosis

78

What are the four stages of OCD?

1: stable, covered by cartilage
2: stable on probing
3: unstable on probing
4: dislocated fragment

79

Kohlers

navicular , male 4-6

80

freiberg infraction

2nd metatarsal head, young girls

81

severs

calcaneal apophysis

82

panners

capitellum, 5-10 yo, thrower

83

perthes

femoral head, 4-8 yo white kid

84

kienbock

lunate

85

What is in the first compartment of the wrist and what disease?

APL, EPB de quervains

86

What is in the third compartment?

EPL beside listers tubercle

87

What is in the sixth compartment?

ECU can get early tenosynovitis in RA

88

What are the 4 bony prominences of the carpal tunnel?

pisifrom, scaphoid tubercle, hook of hamate, trapezium tubercle

89

What does the carpal tunnel lie deep to?

palmaris longus

90

What ten things are in the carpal tunnel?

4 flexor profundus, 4 flexor superficials, 1 flexor pollicis longus, 1 median nerve

91

What synovial spaces normally communicate in the wrist?

pisiform recess and radiocarpal joint

92

Do the glenohumeral joint and subacromial bursa communicate normally?

NO. if they do concerning for full RC tear

93

Does ankle join normally communicate with lateral peronal tendon sheath?

NO. implies tear of calcaneofibular ligament

94

Achilles tendon and posterior subtalar joint communicate?

NO. achilles does not have true tendon sheath

95

What is intersection syndrome?

seen in rowers. first extensor compartment crosses over second leading to ECR brevis and longus tenosynovitis

96

What is most affected in nontuberculous mycobacterial tenosynovitis?

hand and wrist

97

isolated 1st compartment

dequervains

98

1st and 2nd compartment

intersecting

99

isolated 6th

early RA

100

multiple flexor compartents

RA

101

What are the three common finger tumors?

glomus, giant cell tumor, fibroma

102

Glomus tumor painful?

YES but diasppaears with tourniquet= hildreth sign

103

What does glomus tumor look like on MRI?

T2 bright, enhances avidly

104

Painless finger tumor with history of trauma

epidermoid

105

GCT characterisistics on MRI

T1 T2 dark, bloom on gradient

106

FIbroma characteristics on MRI

T1 T2 dark, will NOT bloom

107

Where doe the ulnar collateral ligament attach?

medial coronoid-sublime tubercle

108

What is the Tsign?

partial UCL tear

109

What age is panners?

5-10

110

Lateral epicondylitis what tendon?

extensor carpi radialis brevis. tennis.

111

Medial epiconsylitis tendon?

common flexor tendon and ulnar nerve. golfer

112

What are the three causes of external impingement of the rotator cuff?

hooked acromion, subcromial osteophyte formation, subcoracoid impingement

113

subacromial impingement damages what tendon?

supraspinatus

114

subcoracoid impingement damages what tendon?

subscapularis

115

posterior superior internal impingement damages what tendon?

undersurface of infraspinatus

116

loss of fat in rotator cuff interval=

adhesive capsulitis

117

thickened inferior and posterior capsule=

adhesive capsulitis shoulder

118

decreased glenohumeral volume-

adhesive capsulitis (increased is multidirectional instability)

119

enhancement of rotator cuff interval=

adhesive capsulitis

120

where is the sublabral recess?

incompolete attachment at 12 o clock

121

Where is the sublabral foramen?

1-3 o clock

122

What is the buford complex?

absent labrum 1-3 o clock with thickened middle glenohumeral ligament

123

GLAD

glenolabral articular disruption. superficial anterior inferior labral tear

124

perthes

detachement of labrum 3-6 o clock with stripped but intact periosteum

125

ALPSA

anterior labral periosteal sleeve avulsion. periosteum intact. medially displaoced GH complex

126

true bankart

periosteum is disrupted

127

reverse osseous bankart

gtsvyfracture of posterior inferior rim of glenoid

128

POLPSA?

posterior labrum and posterior scapular periosteum stripped from glenoid

129

bennett lesion

extra articular curvilinear calcification due to injury of posterior inferior glenohumeral ligament

130

kims lesion

avulsed posterior inferior labrum. glenoid cartilage and posterior labrum relationship preserved

131

Hagl

humeral avulsion glenohumeral ligament. avulsion of inferior gh ligament

132

cyst at level of suprascapular notch affects

supraspinatus and infraspinatus

133

cyst at the level of spinoglenoid notch affects

infraspinatus

134

What are the four borders of the quadrilateral space?

teres minor above, ters major below,humeral neck lateral, triceps medial

135

What is quadrilateral space sydnrome?

axillary nerve leads to teres minor atrophy

136

What is the blood supply of the menisci?

geniculate arteries

137

What ar ethe two menisco femoral ligaments?

wriserg and humprey. wrisberg humps humphrey

138

What ist he conjoint tendon made up of?

bicep femoris, LCL

139

What is the meniscal ossicle?

ossification of the posterior horn of the meidal meniscus

140

What is odonoghues unhappy triad

acl mcl tears with medial meniscal injury

141

Posterior lateral corner involves what anatomy?

LCL IT band biceps femoris popliteus tendon

142

what is the primary factor in preventing impingement in acl repair?

position of tibial tunnel

143

what is the primary factor in maintaining isometry in acl repair?

position of femoral tunnel

144

graft tear is most likely to occur when

4-8 months post op

145

What ligament of the ankle is most frequently injurged?

ATFL

146

acute flat arch=

posterior tibial tendon tear at insertion on navicular

147

chronic ptt tear=

medial malleolus

148

meniscoid mass in lateral gutter of ankle=

anterolateral impingement syndrome

149

mortons neuroma is where?

between third and fourth metatarsal heads

150

sequestration ddx=

osteo eg lymphoma fibrosarcoma

151

What mimics spinal tb?

brucellosis

152

diaphyseal expansile lesion with soft tissue swelling of bones of hands and feet=

tb dactylitis (spina ventosa)

153

rice bodies seen in 2

TB, end stage RA

154

What are the three reasons to be concerned for pathollogic fracture

lytic lesion
lesion over 3 cm
lesions involving over 50% of cortex

155

Parosteal osteosarcoma is located where?

posterior distal femur

156

string sign=

parosteal osteosarcoma

157

periosteal osteosarcoma where?

posterior medial femur

158

age group for periosteal osteosarcoma

15-25

159

age group for parosteal osteosarcoma

early adult/middle age

160

bone infarcts can turn into

MFH

161

MFH what age group and body part?

elderly proximal arms/legs

162

MFH on T2?

intermediate

163

Synovial sarcoma age and location

20-40, peripheral lower extremities

164

synovial sarcoma on t2?

triple sign

165

bowl of grapes=

synovial sarcoma

166

what is the translocation in synovial sarcoma?

x 18

167

What is the most common malignancy in teens of the lower extremity?

synovial sarcoma

168

What is the most common liposarcoma in patients under 20?

myxoid liposarcoma

169

What is Mazabraud?

polyostotic fibrous dysplasia and multiple soft tissue myxomas

170

osteosarcoma treatment?

chemo first then wide excision

171

Ewing treatment?

cheo rad then wide excision

172

chondrosarcoma treatment?

only wide excision

173

Giant cell tumor treatment?

arthroplasty

174

What does myositis ossificans look like?

centeral lucency with peripheral calcifications

175

5 lesions under 30?

EG ABC NOF chondroblastoma SBC

176

Epiphyseal lesions? 4

AIGC

ABC infection giant cell chondroblastoma

177

What are the four epiphyseal equivalents?

carpals, patella, greater trochanter, calcaneus

178

long lesion in long bone=

fibrous dysplasia

179

shepherd crook deformity

femur, fibrous dysplasia

180

What are the features of mccune albright?

polyostotic fibrous dysplasia, cafe au lait spots, precocious puberty, girl

181

tibial lesion resembling fibrous dysplasia?

adamantinoma

182

What does an enchondroma look like?

lytic with speckled calcs, chondroid matrix

183

What does an enchondroma look like in the hands and feet?

lytic lesions

184

How to differentiate between enchondroma and chondrosarcoma low grade?

pain

185

DDX for osseous sequestrum?

osteomyelitis, lymphoma, fibrosarcoma, eg, osteoid osteoma

186

3 features of GCT?

physis must be closed, non scelrotic border, abuts articular surface

187

age of GCT?

20-30

188

NOF features?

eccentric with thin scelortic border

189

What is Jaffe campanacci syndrome?

NOFS, cafe au lait, MR, hypogonadism, cardiac malformations

190

3 ddx for lucent lesions in posterior elements

osteoblastoma, abc, tb

191

chondroblastoma features

kid, tibial epiphysis or epiphyseal equivalent with thin sclerotic rim and extension across physeal plate

192

chondromyxoid fibroma

eccentric metaphysea lesion with cortical expansion and bite like configuration

193

greater trochanter 4 ddx

chondroblastoma, abc infection GCT

194

intertrochanteric region ddx 3

lipoma, sbc, monostotic fibrous dysplasia

195

3 classic blastic mets

prostate carcinoid medulloblastoma

196

two classic lytic mets

renal and thyroid

197

mini brain appearance in vertebral body

plasmacytoma

198

What is POEMS?

myeloma with sclerotic mets

199

liposclerosing myxofibroma characteristics

geographic lytic lesion with sclerotic margin at intertrochanteric region

200

what is the only benign skeletal tumor associated with radiation?

osteochondroma

201

cap over what size of osteochondroma is concerning for malignant transformation?

over 1.5cm

202

What is trevor disease?

dyspasia epiphysealis hemimelica; osteochondroma in epiphyses leading to joint deformity

203

what nerve does a supracondylar spur compress?

median nerve if ligament of struthers compresses

204

kid finger lesion with saucerization of cortex

periosteal chondroma

205

looks like NOF in anterior tibia with bowing in kid

osteofibrous dysplasia

206

erosive OA 3 characteristics

gull wing, central erosions favors DIPs

207

characteristics of RA

osteoporosis, soft tissue swelling, marginal erosion with uniform joint space narrowing. bilateral and symmetric

208

What is the first spot in the foot to be affected with RA?

5th metatarsal head

209

What is affected in hands in RA?

PIP then MCP. first CMC spared!

210

RA + SMG + neutropenia

felt

211

RA + pneumoconiosis

Caplan

212

classic description of psoriatic arthritis

erosive change with bone proliferation IP>MCP

213

fuzzy bone appearance around joint=

PA

214

ivory phalanx=

PA

215

mouse ears=

PA

216

acro osteolysis=

PA

217

ankylosis in hand= 2

erosive OA or psoriasis

218

Reiters characteristics?

bone proliferation and erosion, asymmetric SI, affects waist down

219

What are the 5 gout mimickers?

American Roentgen Ray Society Hooray

amyloid
RA
reticular histocytosis
sarcoid
hyperlipidemia

220

degenerative change in an uncommon joint=

CPPD

221

hooked osteophytes on MCP = 2

hemacromatosis or CPPD

222

hyper PTH buzzwords

subperosteal bone resorption
rugger jersey spine
brown tumors
tuft erosion

223

what is Milwaukee shoulder?

due to hydroxyapatite- joint destruction with loose bodies

224

cervical spine fusion = 2

klippel feil or RA juvenile

225

erosion of dens= 2

CPPD RA

226

bad cervical kyphosis =

NF1

227

what is jacouds arthropathy

ulnar deviation of hand with post rheumatic fever (ddx lupus)

228

what antibody is positive in mixed connective tissue disease?

RNP

229

epiphyseal overgrowth=

juvenile idiopathic arthritis

230

what does JIA look like in the hand

jacked carpals with ankylosis

231

particle disease occurs when?

1-5 years post surgery (smooth scalloping)

232

what is the pattern of marrow conversion?

epiphyses, diaphysis, distal metaphysis, proximal metaphysis

233

destructive mass in bone of a leukemia patient

granulocytic sarcoma/chloroma

234

What is Engleman's disease?

progressive diaphyseal dysplasia/PDD with fusiform bony enlargement and sclerosis of long bones

235

What is PVNS?

synovial proliferation and hemosiderin deposition->blooms on GRE`

236

synovial chondromatosis

multiple cartilaginous nodules of joint synovium. with loose bodies. calcifies

237

widening in joint space of adult hip=

gigantism

238

What are the five stages of osteonecrosis?

0 normal
1. normal xr, edema on MR
2. mixed lytic/sclerotic
3 crescent sign, articular collapse, joint space preserved
4. secondary osteoarthritis

239

What are buzzwords in thalassemia?

hair on end skull, rodent faces, expanded ribs/jail bars

240

What is the most common complication of pagets?

deafness

241

What does pagets look like on bone scan?

hot on all three phases

242

plantar fasciits involves which band?

central band