Flashcards in MSK Deck (242):
How fast do phalanges heal?
quickly. 3 weeks
How fast does the tibia heal?
slowly. 10 weeks
How fast do bones typically heal?
What does AVN look like on T1
What band is most important in scapho lunate ligament?
What is considered widening of scapho lunate space?
What ligament disruption and fracture is associated with mid carpal dislocation?
triquetro lunate ligament
lunate dislocation occurs with what ligament injury?
dorsal radiolunate ligament
radial sided, SL ligament injury
normal scaphoid lunate angle?
Two fractures at the base of the first metacarpal?
bennett and rolando
THe pull of what tendon causes dorsolateral dislocation in Bennett Fracture?
abductor pollicis longus
What is gamekeepers thumb?
avulsion at base of proximal first phalanx with ulnar collateral ligament disruption
What is a Stener Lesion?
adductor tendon gets caught in torn edges of UCL (in gamekeepers thumb)
yoyo appearance on MRI
Carpal tunnel syndrome is associated with what four things?
dialysis, pregnancy, DM, hypothyroidism
Guyons canal is formed by what bones?
pisiform and hamate
What gets entrapped in guyons canal?
What is handle bar palsy?
ulnar nerve entrapment in guyon canal
What is a barton fracture?
radial rim fracture with radial carpal dislocation
How do you know a lateral wrist radiograph is true?
volar cortex of pisiform overlies central 1/3 of interval between scaphoid and capitate
Which tendon is associated with the TFCC?
extensor carpi ulnaris/compartment 6
Injury where in the TFCC is good?
Fracture of what is associated with posterior dislocation of the elbow?
What is Essex Lopressi fracture?
fracture or radial head and anterior dislocation of DRUJ
What is osbornes ligament?
epicondylo olecranon ligament, covering cubital tunnel
Cubital tunnel syndrome can be secondary to what acessory muscle?
What is the rim sign?
no overlap of glenoid and humeral head due to posterior dislocation
What is the trough sign?
reverse hill sachs due to impaction on anterior humerus in posterior dislocation
What are the 4 main types of shoulder prosthesis?
humeral head resurfacing, hemi arthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty
Glenoid and cuff intact
resurfacing or hemi
glenoid intact, cuff deficient
hemi or reverse
glenoid deficient, cuff intact
glenoid and cuff deficient
What is the most common complication of total shoulder?
loosening of the glenoid component
What is the anterior escape complication in total shoulder?
anterior migration of humeral head after subscap failure
What is a reverse shoulder complication
posterior acromion fracture due to deltoid tugging
Pubic symphysis avulsion
ischial tuberosity avulsion
lesser trochanter avulsion
greater trochanter avulsion
gluteus medius and minimus
What are three types of snapping hip syndrome?
extrenal internal intra articular
What is the most common type of snapping hip syndrome?
external. IT band over greater trochanter
What is internal snapping hip syndrome?
illiopsoas over illiopectineal eminence or femoral head
What is the intra articular snapping hip syndrome?
labral tears or joint bodies
What age is CAM FAI seen in?
What is a segond fracture?
lateral tibial plateau a/w ACL tear, occurs with interal rotation
What is a reverse segond fracture?
medial tibial plateau fracture a/w pcl tear due to external rotation. also medial meniscus injury
What is arcuate sign?
avulsion of proximal fibula, associated with PCL tear
What is the deep intercondylar notch sign?
depressed lateral femoral condyle a/w acl tear
What ist he classic association with patella alta?
bilateral patellar rupture=
What ist he most common type of tibial plateua fracture?
type 2 split and depressed lateral plateau
What is a pilon fracture?
tibial plafond fracture
What is a tillaux fracture?
salter harris type 3 through tibial epiphysis
What is a triplane fracture?
salter harris 4
medial malleolus and proximal fibular fx
What is the casanova fracture?
bilateral calcaneal w/ spine fracture
Bohlers angle less than what is concerning for fracture?
Where is a Jones fracture?
base of fifth metatarsal, 1.5cm from tuberosity
What is fifth metatarsal avulsion fracture due to?
tug from lateral cord of plantar aponeurosis or peroneus brevis
What is the most common dislocation of the foot?
What is the fleck sign?
osseous fragment in lisfranc space a/w LF ligament disruption
Two diseases with looser zones?
rickets and osteomalacia
T score is what?
relative to young adults
-1 to -2.5
Reflex sympathetic dystrophy is also called what?
complex regional pain syndrome or sudeck atrophy
looks like unilateral RA with preserved joint spaces?
Transient osteoporosis of the hip is most common in what type of patient?
pregnant third trimester
joint pain that improves, but then migrates?
regional migratory osteoporosis
What are the four stages of OCD?
1: stable, covered by cartilage
2: stable on probing
3: unstable on probing
4: dislocated fragment
navicular , male 4-6
2nd metatarsal head, young girls
capitellum, 5-10 yo, thrower
femoral head, 4-8 yo white kid
What is in the first compartment of the wrist and what disease?
APL, EPB de quervains
What is in the third compartment?
EPL beside listers tubercle
What is in the sixth compartment?
ECU can get early tenosynovitis in RA
What are the 4 bony prominences of the carpal tunnel?
pisifrom, scaphoid tubercle, hook of hamate, trapezium tubercle
What does the carpal tunnel lie deep to?
What ten things are in the carpal tunnel?
4 flexor profundus, 4 flexor superficials, 1 flexor pollicis longus, 1 median nerve
What synovial spaces normally communicate in the wrist?
pisiform recess and radiocarpal joint
Do the glenohumeral joint and subacromial bursa communicate normally?
NO. if they do concerning for full RC tear
Does ankle join normally communicate with lateral peronal tendon sheath?
NO. implies tear of calcaneofibular ligament
Achilles tendon and posterior subtalar joint communicate?
NO. achilles does not have true tendon sheath
What is intersection syndrome?
seen in rowers. first extensor compartment crosses over second leading to ECR brevis and longus tenosynovitis
What is most affected in nontuberculous mycobacterial tenosynovitis?
hand and wrist
isolated 1st compartment
1st and 2nd compartment
multiple flexor compartents
What are the three common finger tumors?
glomus, giant cell tumor, fibroma
Glomus tumor painful?
YES but diasppaears with tourniquet= hildreth sign
What does glomus tumor look like on MRI?
T2 bright, enhances avidly
Painless finger tumor with history of trauma
GCT characterisistics on MRI
T1 T2 dark, bloom on gradient
FIbroma characteristics on MRI
T1 T2 dark, will NOT bloom
Where doe the ulnar collateral ligament attach?
medial coronoid-sublime tubercle
What is the Tsign?
partial UCL tear
What age is panners?
Lateral epicondylitis what tendon?
extensor carpi radialis brevis. tennis.
Medial epiconsylitis tendon?
common flexor tendon and ulnar nerve. golfer
What are the three causes of external impingement of the rotator cuff?
hooked acromion, subcromial osteophyte formation, subcoracoid impingement
subacromial impingement damages what tendon?
subcoracoid impingement damages what tendon?
posterior superior internal impingement damages what tendon?
undersurface of infraspinatus
loss of fat in rotator cuff interval=
thickened inferior and posterior capsule=
adhesive capsulitis shoulder
decreased glenohumeral volume-
adhesive capsulitis (increased is multidirectional instability)
enhancement of rotator cuff interval=
where is the sublabral recess?
incompolete attachment at 12 o clock
Where is the sublabral foramen?
1-3 o clock
What is the buford complex?
absent labrum 1-3 o clock with thickened middle glenohumeral ligament
glenolabral articular disruption. superficial anterior inferior labral tear
detachement of labrum 3-6 o clock with stripped but intact periosteum
anterior labral periosteal sleeve avulsion. periosteum intact. medially displaoced GH complex
periosteum is disrupted
reverse osseous bankart
gtsvyfracture of posterior inferior rim of glenoid
posterior labrum and posterior scapular periosteum stripped from glenoid
extra articular curvilinear calcification due to injury of posterior inferior glenohumeral ligament
avulsed posterior inferior labrum. glenoid cartilage and posterior labrum relationship preserved
humeral avulsion glenohumeral ligament. avulsion of inferior gh ligament
cyst at level of suprascapular notch affects
supraspinatus and infraspinatus
cyst at the level of spinoglenoid notch affects
What are the four borders of the quadrilateral space?
teres minor above, ters major below,humeral neck lateral, triceps medial
What is quadrilateral space sydnrome?
axillary nerve leads to teres minor atrophy
What is the blood supply of the menisci?
What ar ethe two menisco femoral ligaments?
wriserg and humprey. wrisberg humps humphrey
What ist he conjoint tendon made up of?
bicep femoris, LCL
What is the meniscal ossicle?
ossification of the posterior horn of the meidal meniscus
What is odonoghues unhappy triad
acl mcl tears with medial meniscal injury
Posterior lateral corner involves what anatomy?
LCL IT band biceps femoris popliteus tendon
what is the primary factor in preventing impingement in acl repair?
position of tibial tunnel
what is the primary factor in maintaining isometry in acl repair?
position of femoral tunnel
graft tear is most likely to occur when
4-8 months post op
What ligament of the ankle is most frequently injurged?
acute flat arch=
posterior tibial tendon tear at insertion on navicular
chronic ptt tear=
meniscoid mass in lateral gutter of ankle=
anterolateral impingement syndrome
mortons neuroma is where?
between third and fourth metatarsal heads
osteo eg lymphoma fibrosarcoma
What mimics spinal tb?
diaphyseal expansile lesion with soft tissue swelling of bones of hands and feet=
tb dactylitis (spina ventosa)
rice bodies seen in 2
TB, end stage RA
What are the three reasons to be concerned for pathollogic fracture
lesion over 3 cm
lesions involving over 50% of cortex
Parosteal osteosarcoma is located where?
posterior distal femur
periosteal osteosarcoma where?
posterior medial femur
age group for periosteal osteosarcoma
age group for parosteal osteosarcoma
early adult/middle age
bone infarcts can turn into
MFH what age group and body part?
elderly proximal arms/legs
MFH on T2?
Synovial sarcoma age and location
20-40, peripheral lower extremities
synovial sarcoma on t2?
bowl of grapes=
what is the translocation in synovial sarcoma?
What is the most common malignancy in teens of the lower extremity?
What is the most common liposarcoma in patients under 20?
What is Mazabraud?
polyostotic fibrous dysplasia and multiple soft tissue myxomas
chemo first then wide excision
cheo rad then wide excision
only wide excision
Giant cell tumor treatment?
What does myositis ossificans look like?
centeral lucency with peripheral calcifications
5 lesions under 30?
EG ABC NOF chondroblastoma SBC
Epiphyseal lesions? 4
ABC infection giant cell chondroblastoma
What are the four epiphyseal equivalents?
carpals, patella, greater trochanter, calcaneus
long lesion in long bone=
shepherd crook deformity
femur, fibrous dysplasia
What are the features of mccune albright?
polyostotic fibrous dysplasia, cafe au lait spots, precocious puberty, girl
tibial lesion resembling fibrous dysplasia?
What does an enchondroma look like?
lytic with speckled calcs, chondroid matrix
What does an enchondroma look like in the hands and feet?
How to differentiate between enchondroma and chondrosarcoma low grade?
DDX for osseous sequestrum?
osteomyelitis, lymphoma, fibrosarcoma, eg, osteoid osteoma
3 features of GCT?
physis must be closed, non scelrotic border, abuts articular surface
age of GCT?
eccentric with thin scelortic border
What is Jaffe campanacci syndrome?
NOFS, cafe au lait, MR, hypogonadism, cardiac malformations
3 ddx for lucent lesions in posterior elements
osteoblastoma, abc, tb
kid, tibial epiphysis or epiphyseal equivalent with thin sclerotic rim and extension across physeal plate
eccentric metaphysea lesion with cortical expansion and bite like configuration
greater trochanter 4 ddx
chondroblastoma, abc infection GCT
intertrochanteric region ddx 3
lipoma, sbc, monostotic fibrous dysplasia
3 classic blastic mets
prostate carcinoid medulloblastoma
two classic lytic mets
renal and thyroid
mini brain appearance in vertebral body
What is POEMS?
myeloma with sclerotic mets
liposclerosing myxofibroma characteristics
geographic lytic lesion with sclerotic margin at intertrochanteric region
what is the only benign skeletal tumor associated with radiation?
cap over what size of osteochondroma is concerning for malignant transformation?
What is trevor disease?
dyspasia epiphysealis hemimelica; osteochondroma in epiphyses leading to joint deformity
what nerve does a supracondylar spur compress?
median nerve if ligament of struthers compresses
kid finger lesion with saucerization of cortex
looks like NOF in anterior tibia with bowing in kid
erosive OA 3 characteristics
gull wing, central erosions favors DIPs
characteristics of RA
osteoporosis, soft tissue swelling, marginal erosion with uniform joint space narrowing. bilateral and symmetric
What is the first spot in the foot to be affected with RA?
5th metatarsal head
What is affected in hands in RA?
PIP then MCP. first CMC spared!
RA + SMG + neutropenia
RA + pneumoconiosis
classic description of psoriatic arthritis
erosive change with bone proliferation IP>MCP
fuzzy bone appearance around joint=
ankylosis in hand= 2
erosive OA or psoriasis
bone proliferation and erosion, asymmetric SI, affects waist down
What are the 5 gout mimickers?
American Roentgen Ray Society Hooray
degenerative change in an uncommon joint=
hooked osteophytes on MCP = 2
hemacromatosis or CPPD
hyper PTH buzzwords
subperosteal bone resorption
rugger jersey spine
what is Milwaukee shoulder?
due to hydroxyapatite- joint destruction with loose bodies
cervical spine fusion = 2
klippel feil or RA juvenile
erosion of dens= 2
bad cervical kyphosis =
what is jacouds arthropathy
ulnar deviation of hand with post rheumatic fever (ddx lupus)
what antibody is positive in mixed connective tissue disease?
juvenile idiopathic arthritis
what does JIA look like in the hand
jacked carpals with ankylosis
particle disease occurs when?
1-5 years post surgery (smooth scalloping)
what is the pattern of marrow conversion?
epiphyses, diaphysis, distal metaphysis, proximal metaphysis
destructive mass in bone of a leukemia patient
What is Engleman's disease?
progressive diaphyseal dysplasia/PDD with fusiform bony enlargement and sclerosis of long bones
What is PVNS?
synovial proliferation and hemosiderin deposition->blooms on GRE`
multiple cartilaginous nodules of joint synovium. with loose bodies. calcifies
widening in joint space of adult hip=
What are the five stages of osteonecrosis?
1. normal xr, edema on MR
2. mixed lytic/sclerotic
3 crescent sign, articular collapse, joint space preserved
4. secondary osteoarthritis
What are buzzwords in thalassemia?
hair on end skull, rodent faces, expanded ribs/jail bars
What is the most common complication of pagets?
What does pagets look like on bone scan?
hot on all three phases