MSK Pathology

Question 1

What pathology in tendons are the final stage of progressive destruction of fibers?

Answer 1

Rupture

Question 2

What are 2 INDIRECT signs of a partial thickness tear?

Answer 2

1. Bursal thickening
2. Fluid in tendon sheath

Question 3

What pathology is defined as ‘forcible separation or detachment’ or ‘tearing away a body part’

Answer 3

Avulsions - when tendon or muscle is pulled away from the bone and bone fragments are seen within the muscle or tendon

Question 4

What pathology is defined as “degenerative changes w/out signs of inflammation”

Answer 4

Tendinosis - caused by repetitive microtrauma of overuse injuries

Question 5

With color and power doppler, does Tendinosis have blood flow occurring at the deep or superficial side of the tendon?

Answer 5

Deep side - neovascularity

Question 6

What Tendon’s are usually affected by tendinosis?

Answer 6

Patellar tendon - jumpers knee - usually affects the upper insertion of the tendon

Achilles tendon - usually affects the middle 1/3rd of the tendon

Question 7

What tendon is involved in ‘jumpers knee’?

Answer 7

Patellar tendon

Question 8

What pathology is defined as “edema associated w/ inflammation and causes thickening and decreased echogenicity of tendons”

Answer 8

Tendonitis

Question 9

SF of acute tendonitis?

Answer 9

1. Decreased echogenicity
2. Thickened
3. Irregular margins
4. Increased vascularity within the tendon

Question 10

SF of chronic tendonitis?

Answer 10

1. Deformed tendon margins/bumpy appearance
2. Intra-tendon calcifications

Question 11

What pathology is known as the inflammation of the tendon sheath?

Answer 11

Tenosynovitis

Question 12

What 3 locations does synovitis typically occur?

Answer 12

1. Hand
2. Wrist
3. Ankle

Question 13

Acute cases of tenosynovitis are most often caused by what two things?

Answer 13

1. Pyogenic infection
2. Microtrauma

Question 14

What are the acute vs. chronic SF of tenosynovitis?

Answer 14

Acute - fluid in sheath

Chronic - thickened sheath with some or no fluid

Question 15

What pathology is defined as the “inflammation of the 2 tendons and their sheath that control the movement of thumb over the radius”?

Answer 15

De-Quervain’s tenosynovitis- affects compartment 1

Question 16

What pathology is defined as inflammation of the INSERTION of tendons on to bones?

Answer 16

Enthesopathy

Question 17

Enthesopathy is most common at what 3 sites in the body?

Answer 17

1. Achilles tendon
2. Patellar tendon
3. Plantar Fascia

Question 18

T or F? Soft tissue tumors are cell growths that emerge anywhere in the body?

Answer 18

TRUE

Question 19

On ultrasound while scanning the index finger, you see a hypoechoic mass with lobulated contours on a 40 year old woman with internal vascularity. What is the most likely diagnosis? slide 14

Answer 19

Giant cell tumor of the tendon sheath which is BENIGN

Question 20

What is the name of the malignant tumor that arises from the tendon sheath?

Answer 20

Synovial Sarcomas - hypoechoic mass, lobulated, with calcifications

Question 21

What pathology is seen when a nodule is compressible with transducer pressure and has NO posterior shadowing or color flow?

Answer 21

Pseudo-tumour

Question 22

What MSK pathology appears as a homogeneous, oval, isoechoic mass, with little or no flow on color or power Doppler imaging, soft and pliable with transducer pressure?

Answer 22

Lipoma

Question 23

Foreign Body appearance over time?

Answer 23

Acute <3 days: Hyperechoic with posterior shadow due to air

Intermediate 3-10 days: Hypoechoic halo surrounding foreign body - air replaced with fluid

Chronic >10 days: Granulation formation and may have a shadow

Question 24

What are the SF of nerve entrapment?

Answer 24

1. Hypoechoic swelling of the nerve proximally at entrapment site
2. Distal compression of the nerve
3. Pain with transducer pressure

Question 25

What is the most common cause of bursitis?

Answer 25

Trauma Often occurs in the presence of Tendinosis

Question 26

Acute vs chronic SF of bursitis?

Answer 26

Acute - Fluid collection Chronic - Hypervascular walls, complex, debris, possible calcifications

Question 27

What pathology is composed of benign lumps that develop from a joint or tendon sheath, most commonly found in the hand or wrist?

Answer 27

Ganglion cysts - anechoic round appearance and filled with a hard jelly-like substance - are NOT compressible

Question 28

What pathology is caused by abnormal distension of the gastrocnemiosemimembranous bursa, which communicates w/ knee joint?

Answer 28

Baker's cyst - medial gastrocnemius and semi- membranous tendon

Question 29

A tear of the muscle is the most common muscle pathology and is often associated with what?

Answer 29

Hematoma

Question 30

What pathology demonstrates a 'clapper in a bell' sign?

Answer 30

Complete muscle tear - retracted muscle surrounded by a hematoma

Question 31

What are the 3 grades of acute muscle injury?

Answer 31

Grade 1: No fiber disruption seen Grade 2: Partial tear, moderate fiber disruption, compromised strength Grade 3: Complete fiber disruption and retraction

Question 32

What are the 3 types of muscle injuries?

Answer 32

1. Direct - usually muscle demonstrates disorganized fibers 2. Stretch - common where muscles spans over two joints 3. Penetrating - usually result in partial or full thickness tears. Gas can be introduced into the injury site.

Question 33

Which muscle injury is most common in children?

Answer 33

Stretch injury

Question 34

SF of chronic muscle injury?

Answer 34

Hyperechoic and atrophied muscle

Question 35

A damaged muscle can ossify and you will be able to see the mineralization on U/S before CT. What is this called? (called myositis ossificans)

Answer 35

Myositis Ossificans

Question 35

SF of hemorrhage by stage?

Answer 35

Initial injury - hyperechoic After 36+ hours - becomes anechoic as it liquifies and becomes smaller as it reabsorbs Chronic - Becomes echogenic at surrounding edges

Question 36

What are the different types of bone fractures?

Answer 36

Acute fracture - discontinuity of the bone and often seen with hemorrhage Stress fracture - Focal hypoechoic area beside bone - patient may feel focal pain and tenderness Osteophytes or bone spurs - bony growths occurring at margins of synovial joints - usually DO NOT present with tenderness or pain