MSK Trauma Flashcards
1
Q
differentiate: fatigue fx vs insuff fx
A
fatigue: normal bone –> repetitive stress –> fx
insuff: abn bone –> normal stress –> fx
2
Q
tenosynovitis –> cause? (3)
A
- repetitive motion
- inflamm arthritis
- infx
3
Q
tenosynovitis –> MRI appearance?
A
tendon –> completely surround by fluid
4
Q
what is stenosing tenosynovitis?
A
tendon sheath –> several loculated fluid collections
5
Q
what is myxoid degeneration (tendinosis)?
A
age/over-use –> tendon –> non-inflamm degen
6
Q
myxoid degeneration (tendinosis) –> MRI appearance?
A
tendon:
- normal size or enlrg
- intermed signal within
7
Q
Jones fx –> location?
A
5th metatarsal –> prox –> meta-diaphysis jx
8
Q
pseudo-Jones fx (metatarsal base avulsion fx) –> location?
A
5th metatarsal base –> intra-articular
9
Q
differentiate: Jones vs pseudo-Jones fx –> prognosis? tx?
A
Jones fx:
- reduced blood supply –> worse prognosis
- tx variable –> maybe surg
pseudoJones:
- conservative managemt
10
Q
pseudo-Jones fx (metatarsal base avulsion fx) –> which tendon?
A
peroneus brevis
11
Q
what is Freiberg’s infraction?
A
2nd metatarsal –> head –> avascular necrosis
12
Q
Freiberg’s infraction –> epidemiology?
A
young F
13
Q
Freiberg’s infraction –> cause? (2)
A
- repetitive stress
- poor fit shoes (heels)
14
Q
1st toe –> sesamoid fx –> MOA?
A
1st MTP:
- extreme hyperextend
- dorsal dislocate
15
Q
what is turf toe?
A
wide range of injuries of 1st MTP jt –> include sesamoid fx
16
Q
Lisfranc injury –> 2 dislocation types?
A
- divergent: 1st metatarsal –> medial dislocate
- homolat: all metatarsals –> lat dislocate
17
Q
what is Kohler dz?
A
peds –> navicular –> osteonecrosis
18
Q
what is Mueller-Weiss dz?
A
adult –> navicular –> osteonecrosis
19
Q
Kohler dz –> epidemiology?
A
M
20
Q
Mueller-Weiss dz –> epidemiology?
A
F
21
Q
differentiate: Kohler dz vs Mueller-Weiss dz –> prognosis?
A
Kohler –> self-limited
Mueller-Weiss: more severe in course
22
Q
what is Chopart jt?
A
talonavicular + calcaneocuboid jt
23
Q
Chopart fx-dislocation –> assoc fx? (3)
A
- calcaneus
- cuboid
- navicular
24
Q
what is lover’s fx?
A
fall from ht –> calcaneus fx
25
traumatic calcaneus fx --> next step? why?
high assoc:
- lumbar fx
- traumatic aortic injury
- renal vascular pedicle avulsion
--> further imaging --> lumbar and/or abd
26
how to measure Boehler angle? normal measuremt?
- posterior tuberosity sup aspect --> post subtalar facet sup aspect
- ant process sup aspect --> post subtalar articular surface sup aspect
normal: 20-40 deg
27
calcaneus fx --> diagnostic Boehler angle?
<20 deg
28
calcaneus stress fx --> imaging appearance? Boehler angle?
- calcaneus --> intact cortex --> fluffy band of sclerosis
| - normal Boehler angle
29
talus fx --> which parts of talus can be fractured? (5)
- lat process
- post process
- head
- body
- neck
30
Hawkins classification --> use for what fx?
talar neck fx
31
talar neck fx --> potential comp?
disrupt blood supply --> avascular necrosis
32
what is Hawkins sign?
talar neck fx --> ankle immobilize --> 6-8wk --> intact blood supply --> active hyperemia --> inc bone resorb --> frontal ankle XR --> subchondral lucent band --> good prognosis
33
talar neck fx --> no Hawkins sign --> suggests?
avascular necrosis
34
hindfoot (tarsal) coalition --> 2 MC types?
- talocalcaneal
| - calcaneonavicular
35
what is C sign?
fused middle subtalar jt --> medial talus - sustenaculum tali --> talocalcaneal coalition
36
calcaneonavicular coalition --> fusion of which parts?
calcaneus ant process --> navicular
37
calcaneonavicular coalition --> sign?
anteater sign
38
Danis-Weber classification?
- Weber A: distal fibula fx --> intact syndesmosis
- B: prox trans-syndesmotic fx --> partial syndesmotic rupture
- C: high fibula fx above syndesmosis --> assoc total syndesmotic rupture & ankle mortise instable
39
direction mechanism of trauma?
- Weber A
- B
- C
- Weber A: supination-adduction
- B: supination-ext rot
- C: pronation-ext rot
40
triplane fx --> 3 components?
- epiphysis --> vertical
- physis --> horizontal
- metaphysis --> oblique
41
what is Wagstaffe-LeFort fx?
avulsion fx --> distal fibula --> ant --> ATFL
42
what is maisonneuve fx?
prox fibula fx --> assoc interosseous membrane tear or medial malleolus fx --> wide ankle mortise
43
what is Pilon fx?
distal tibia --> comminute vertical fx --> tibial plafond disrupt
44
Pilon fx --> MOA?
axial loading
45
achilles thicken --> ddx? (2)
- achilles tendinosis
| - hyperlipid --> xanthoma
46
Kager's fat pad --> inc soft tissue --> ddx? (3)
- #1 access soleus muscle
- Achilles tendon injury
- Haglund dz (Mulholland deformity)
47
what is Haglund synd (Mulholland deformity)?
poor fit shoes --> Haglund deformity ("pump bump") --> retrocalcaneal bursitis --> distal Achilles tendon --> thicken
48
knee dislocation --> next step? why?
high risk --> popliteal A injury --> CT angio
49
knee dislocation --> MC type?
ant
50
tibial plateau fx --> lat vs medial --> which is more stable?
lat
51
differentiate: meniscal injury --> red zone vs central --> prognosis?
- red zone: vascular zone --> heal spont or w surg
| - central: avascular --> not heal
52
meniscus --> myxoid degen --> imaging appearance?
inc signal --> not extend to surface
53
meniscal tear --> MC type?
oblique/horizontal tear
54
meniscus --> oblique/horizontal tear --> MC location?
medial meniscus --> post horn
55
meniscus --> oblique/horizontal tear --> MC etiology?
degen
56
meniscus --> what is bucket handle tear?
vertical tear --> inner edge --> displace
57
meniscus --> bucket handle tear --> most sensitive sign?
"absent bow tie"
58
meniscus --> bucket handle tear --> displaced inner edge --> MC location?
intercondylar notch
59
meniscus tear --> double delta sign indicates?
either meniscus --> bucket handle tear --> ant displacement
60
meniscus tear --> double PCL sign indicates?
medial meniscus --> bucket handle tear --> post displacement
61
meniscus --> radial (transverse) tear --> sign? (3)
- "marching cleft" sign
- "ghost meniscus"
- "truncated triangle"
62
meniscus tear --> what is marching cleft sign?
meniscal tear --> oriented obliquely in relation to both coronal and sagittal plane --> tear cleft mv toward/away from free meniscal edge on consecutive sagittal images
63
meniscus tear --> which type has high rate of meniscal extrusion?
radial (transverse)
64
what is meniscal cyst?
meniscus tear --> jt fluid extend into --> loculated fluid adj to meniscus
65
meniscal cyst --> MC assoc meniscus tear?
horizontal tear
66
what is discoid meniscus?
congenital malformation --> meniscus --> range thick to complete disc-shape --> meniscus extend into central tibial plateau
67
discoid meniscus --> ssx?
- jt pain
- clicking
- locking
68
discoid meniscus --> inc risk for? (2)
- cystic degen
| - tear
69
discoid meniscus --> MC in lat or medial meniscus?
lat
70
discoid meniscus --> imaging appearance?
meniscus --> sagittal --> oval or bowtie --> >3 contiguous slices
71
ACL --> 2 attachmts? which attachmt is stronger?
- femoral intercondylar notch
| - ant tibial plateau --> stronger
72
ACL --> 2 fiber bundles? which is smaller/larger?
- ant-med band --> small
| - post-lat --> lrger
73
ACL injury --> 3 assoc injuries?
- meniscal tear
- MCL tear
- postlat corner knee injury
74
what is O'Donoghue's triad?
- ACL injury
- meniscal tear
- MCL tear
75
ACL injury --> charact bone contusion pattern?
- lat femoral condyle
| - postlat tibial plateau
76
ACL injury --> PCL appearance?
tibia --> ant displace --> PCL buckling
77
XR finding --> suggests ACL injury?
Segond fx
78
what is Segond fx?
lat capsular lig --> lat tibial plateau --> avulsion fx
79
Segond fx --> assoc injuries? (2)
- ACL
| - IT band
80
IT band --> inserts?
tibia --> Gerdy's tubercle
81
XR --> Segond fx --> next step?
MRI --> look for ACL injury
82
ACL graft --> should run parallel to what structure? what "line" is used to assess this?
parallel to intercondylar notch --> behind Blumensaat's line
83
ACL graft --> too steep --> potential comp?
extend leg --> graft impinged by femur
84
ACL graft --> too lax --> potential comp?
not provide enough knee stability
85
ACL reconstruction --> what is cyclops lesion?
potential comp of ACL reconstruction --> nodular scarring in Hoffa's fat pad
86
ACL vs PCL --> which is stronger?
PCL
87
PCL --> attachmts?
- femoral intercondylar notch (ant to ACL)
| - post tib plateau
88
PCL injury --> typical MRI appearance?
- inc laxity
| - +/- abnormal T2 signal
89
knee --> extensor mechanism --> 3 components?
- quad tendon
- patella
- patellar tendon
90
quad muscles? (4)
- vastus --> intermedius, medialis, lateralis
| - rectus femoris
91
patella alta --> Insall-Salvati ratio?
>1.2
92
patella baja --> Insall-Salvati ratio?
<0.8
93
Insall-Salvati ratio --> best measured on sagittal view with how much (deg) flexion?
30deg
94
quad tendon tear --> ssx? (1)
can't extend knee
95
quad tendon tear --> XR finding?
patella baja
96
patellar tendon tear --> ssx? (1)
can't extend knee
97
patellar tendon tear --> XR finding?
patella alta
98
patellar tendinosis (jumper's knee) --> MRI appearance?
patellar tendon --> thick
99
lat patella dislocation --> charact pattern of injury?
- bone contusion:
- - lat femoral condyle
- - medial patella facet
- medial retinaculum tear
100
what is Osgood-Schlatter dz? etiology? epidemiology?
adol --> repetitive microtrauma --> tibial tubercle --> osteochondrosis
101
Osgood-Schlatter dz --> XR appearance?
- tibial tuberosity --> enlrg, fragmted
| - adj edema
102
Osgood-Schlatter dz --> MR appearance?
- tibial tubercle --> BM edema
- distal patellar tendon --> inc signal
- Hoffa's fat pad --> edema
103
MCL --> 2 attachmts?
- medial femoral condyle --> post aspect
| - tibial metaphysis --> medial aspect --> deep to pes anserinus
104
MCL injury --> 3 grades?
- Grade 1 --> MCL sprain --> lig normal signal, soft tissue high signal
- 2 --> severe sprain/partial tear --> lig high signal or partial disrupt
- 3 --> complete tear --> complete disrupt
105
what is Pellegrini-Stieda lesion?
MCL avulsion injury --> medial femoral condyle --> adj calc
106
lat collateral lig (LCL) complex --> 3 components?
- biceps femoris tendon
- LCL
- IT band
107
knee --> postlat corner --> componts? (4)
- LCL complex
- arcuate lig
- popliteofibular lig
- popliteus tendon
108
knee --> postlat corner injury --> surgical-near emergency --> T/F?
T
109
IT band synd --> epidemiology? MOA? ssx?
runner --> antlat femur & IT band tendon friction --> antlat knee pain
110
IT band synd --> MRI appearance?
fluid --> both sides of IT band
111
patella --> 3 facets?
- odd
- med
- lat
112
cartilage thinning --> reported measuremts?
- <50%
- 50%
- >50%
113
cartilage injury --> 3 types of manifestations?
- surface irreg
- fissure
- delamination
114
cartilage injury --> what is delamination?
dissecting detachmt of cartilage undersurface from bone
115
what is osteochondrosis dissecans? epidemiology?
adol --> repetitive trauma --> cartilage dehydrate & stiffen --> greater force on subchondral bone --> osteochondral injury
116
osteochondrosis dissecans --> MC jts? (3)
- #1 knee
- #2 ankle
- elbow
117
osteochondrosis dissecans --> knee --> location?
med femoral condyle --> lat aspect
118
osteochondrosis dissecans --> ankle --> location?
talar dome:
- postmed
- antlat
119
osteochondrosis dissecans --> elbow --> location?
capitellum --> antlat
120
elbow --> osteochondrosis dissecans --> epidemiology? (2)
- gymnast
| - throwing athlete
121
unstable osteochondral fragmt --> appearance?
lesion is not attached to bone --> curvilinear fluid signal bw fragmt & bone
122
OCD --> MRI stages? (4) which are unstable?
- stage 1: intact articular cartilage
- 2: articular cartilage defect
- 3: displaceable frgmt --> unstable
- 4: displaced frgmt --> unstable
123
OCD --> MRI stages 1-4 --> XR appearance?
- stage 1: normal
- 2: semicircular frgmt
- 3: semicircular frgmt
- 4: defect or loose body
124
OCD --> MRI stages 1-4 --> T2 appearance?
- stage 1: BM edema
- 2: surrounding low signal, cartilage defect
- 3: surrounding high signal
- 4: defect and/or loose body
125
what is osteochondral injury?
cartilage & bone --> acute traumatic injury (not repetitive)
126
what is pigmented villonodular synovitis (PVNS)?
synovium --> hyperplastic prolif --> benign tumor
127
same process as pigmented villonodular synovitis (PVNS) --> occurs outside the jt --> dx?
giant cell tumor of tendon sheath
128
pigmented villonodular synovitis (PVNS) --> MC location?
knee
129
pigmented villonodular synovitis (PVNS) --> ssx? (3)
- knee pain
- swelling
- knee effusion --> dark brown (d/t prior hemorrhage)
130
pigmented villonodular synovitis (PVNS) --> MR appearance?
- T1
- T2
- GRE
recurrent hemorrhage --> hemosiderin:
- T1 dark
- T2 dark
- GRE bloom
131
what is lipoma arborescens?
intracapsule --> synovium --> fatty tissue --> overgrow --> fatty mass --> lobulated & globular
132
lipoma arborescens --> tx? why?
synovectomy --> prevent premature OA
133
Baker's cyst --> MC location?
Baker's M&M:
- semiMembranosus
- Med head of gastrocnemius
134
what is Baker's cyst?
knee jt --> ball-valve type comm --> popliteal cyst
135
Baker's cyst --> ddx? (1)
popliteal aneurysm
136
what is tennis leg?
tear:
- plantaris tendon
- medial head of gastrocnemius
137
what "line" represents border ant column of acetabulum?
iliopectineal (iliopubic) line
138
what "line" represents border post column of acetabulum?
ilioischial line
139
acetabulum fx --> Judet-Letournel classification --> 5 elementary patterns?
- post wall fx
- post column
- ant wall
- ant column
- transverse
140
hip fx --> intracapsular types? (2)
- femoral head
| - neck
141
intracapsular hip fx --> potential comp?
osteonecrosis
142
femoral head --> major blood supply? minor?
- #1 circumflex femoral A
| - lig teres
143
femoral neck fx --> 3 types? MC type?
- #1 subcapital
- transcervical
- basicervical
144
subcapital femoral neck fx --> Garden classification?
- stage I: impacted or incomplete --> valgus
- II: complete, nondisplaced
- III: complete, partial displace --> varus
- IV: complete, full displace --> varus
145
subcapital femoral neck fx --> normal vs varus vs valgus --> angle measuremts?
- valgus >180
- varus <160
- normal 160
146
hip arthroplasty --> how to optimize MRI?
- field strength
- FSE vs GRE
- receiver bandwidth
- number of acquisitions (NEX)
- artifact direction
- voxel size
- slice thickness
- matrix size
- field strength: low as poss
- FSE vs GRE: FSE
- receiver bandwidth: inc as much as poss
- number of acquisitions (NEX): inc
- artifact direction: sup-inf
- voxel size: dec
- slice thickness: dec
- matrix size: inc
147
hip fx --> MRI appearance?
- fx line --> T1/T2 dark
| - BM edema --> T2 bright
148
what is magic angle artifact?
short TE seq --> tendon --> oriented 55 deg to magnet bore --> inc signal artifact
149
short TE --> which seq? (3)
- T1
- proton density
- GRE
150
hip --> stress fx --> MC location? less common location?
- #1 femoral neck --> infmed
| - femoral head --> sup
151
differentiate: femoral head stress fx vs hip AVN --> imaging appearance?
stress fx --> subchondral line:
- irreg
- convex to articular surface
AVN --> subchondral line:
- smooth
- concave
152
hip AVN --> RF? (2)
- steroid use
| - alcohol abuse
153
femur --> stress fx --> atypical location? poss etiology?
bisphosphonate use:
- diaphysis --> lat
- diaphysis --> transverse
154
hip --> stress fx --> edema should be resolved by?
8wk
155
hip --> stress fx --> conservative tx for 8 wk --> f/u MRI --> persistent edema --> indicates?
tx fail
156
stress fx --> other sites in pelvis? (3)
- pubic rami
- sacrum
- acetabulum --> roof
157
what is AVN? what is osteonecrosis?
AVN: epiphysis/subchondral --> focal ischemia
osteonecrosis: bone & BM --> necrosis
158
AVN --> natural progression of dz?
focal ischemia --> trabecula necrosis --> inc risk for stress fx --> collapse --> 2ary OA
159
AVN + splenomeg --> dx?
Gaucher dz
160
AVN + small calcified spleen --> dx?
sickle cell
161
AVN --> etiology? (4)
- trauma
- red cell abnormal --> sickle cell
- marrow packing abnormal --> Gaucher
- meds --> steroid, alcohol, transplant immunosupp
162
hip --> b/l AVN --> suggests what type of etiology?
systemic
163
AVN --> MC location? 2nd MC?
- #1 prox femur
| - #2 prox humerus
164
what is Ficat staging used for?
hip AVN --> XR appearance --> staging
165
hip AVN --> Ficat staging? tx?
- stage 1: normal XR --> core femoral head drill
- 2: cystic & sclerotic change --> core femoral head drill
- 3: subchondral collapse --> variable tx
- 4: femoral head flat, 2ary OA --> jt replace
166
AVN --> MRI appearance --> 2 classification systems?
- modified Ficat
| - Mitchell system
167
hip AVN --> MC MRI appearance?
- geographic subchondral lesion
| - serpentine rim --> T1 dark
168
pathognomonic sign for AVN?
"double line" sign --> T2:
- peripheral rim --> dark
- inner band --> bright
169
transient BM edema (TBME; transient osteoporosis of hip) --> classic clinical presentation?
young-middle age adult --> M --> severe hip pain
170
transient BM edema (TBME; transient osteoporosis of hip) --> XR appearance?
- femoral head --> osteopenia
- normal jt space, acetabulum
- no erosion
171
transient BM edema (TBME; transient osteoporosis of hip) --> dx of exclusion --> T/F?
T
172
labral injury --> MC location?
antsup
173
what is femoroacetabular impingemt?
extreme ROM --> abnormal abutmt of femur w acetabulum
174
femoroacetabular impingemt --> clinical or imaging dx?
clinical
175
femoroacetabular impingemt --> natural progression of dz?
young athlete --> impingmt --> microtrauma --> chronic --> early OA
176
femoroacetabular impingemt --> RF for what injury?
labral
177
femoroacetabular impingemt --> 3 types? where is the abrnomality?
- cam-type --> femoral head/neck jx
- pincer-type --> acetabulum
- mixed --> both
178
imaging findings of femoroacetabular impingemt --> impression?
findings may predispose to impingemt in the presence of pain
179
femoroacetabular impingemt --> cam-type --> abnrmoal bump on femoral head/neck jx --> etiology? (4)
- childhood SCFE
- Legg-Calve-Perthes
- DDH --> sequela
- fx malunion
180
femoroacetabular impingemt --> cam-type --> epidemiology?
young athlete M
181
femoroacetabular impingemt --> cam-type --> deformity appearance?
"pistol grip"
182
femoroacetabular impingemt --> cam-type --> tx?
femoral osteoplasty
183
femoroacetabular impingemt --> cam-type --> alpha angle is a measure of what?
degree of abnormal femoral bump
184
femoroacetabular impingemt --> cam-type --> angle angle --> how to measure?
- line thru femoral neck
| - line --> femoral head center --> most prox abnormal contour of femoral neck
185
femoroacetabular impingemt --> cam-type --> abnormal angle angle --> measuremt?
>55 deg
186
femoroacetabular impingemt --> pincer-type --> epidemiology?
middle age F
187
femoroacetabular impingemt --> pincer-type --> tx?
surg --> trim acetabular rim
188
femoroacetabular impingemt --> pincer-type --> what is crossover sign (cranial acetabular retroversion)?
XR --> frontal --> ant acetabular wall --> sup aspect --> cross over to post acetabular wall
189
femoroacetabular impingemt --> MC type?
mixed
190
thoracolumbar spine --> ant column --> componts?
- vertebral body --> ant 2/3
| - ALL
191
thoracolumbar spine --> middle column --> componts?
- vertebral body --> post 1/3
| - PLL
192
thoracolumbar spine --> post column --> componts?
- post elemts
| - post lig --> supraspinous, infraspinous, lig flavum
193
thoracolumbar spine --> post column --> 3 columns --> injury to 1 vs 2 vs 3 columns --> stability?
- 1: stable
- 2: un/stable
- 3: unstable
194
chance fx (seat belt fx) --> MOA?
sudden decel --> spine --> acute forward flex --> flexion distraction injury
195
chance fx (seat belt fx) --> appearance?
horizontal split: post elemt --> vertebral body
196
basion-dental interval --> normal?
<12 mm
197
atlanto-dental (atlanto-axial) interval (ADI) --> normal?
- adult <2.5mm
| - child <5
198
what is Jefferson fx? MOA?
axial force --> C1 --> ant & post arch --> symm fx
199
odontoid fx --> 3 types? stability?
- type 1: dens tip --> stable
- 2: base --> unstable
- 3: extend to C2 body --> un/stable
200
what is Hangman's fx? MOA?
hyperextend --> C2 --> bilat pedicles/pars interarticularis --> fx
201
what is clay-shoveler's fx? MOA?
hyperflex --> C6-T1 --> spinous process --> fx
202
odontoid fx --> type 2 --> tx?
surg fusion
203
Hangman's fx --> charact XR finding?
spinolaminar line --> disrupt
204
Hangman's fx --> likely unstable --> what measuremt?
C2-C3 displace >3mm
205
what is burst fx? MOA?
axial load --> C2-C7 --> same as Jefferson fx
206
what is flexion teardrop fx? MOA?
hyperflex & compress --> vertebral body --> post displace --> into spinal canal
207
flexion teardrop fx --> key XR finding? etiology?
ALL avulsion --> vertebral body --> antinf --> bone frgmt
208
flexion teardrop fx --> potential comp?
ant cord synd --> compress pyramidal tract & ant spinothalamic tract
209
flexion teardrop fx --> ant cord synd --> clinical presentation?
- complete paralysis
| - loss --> pain & temp
210
differentiate: flexion vs extension teardrop fx
- location?
- stability?
ext:
- higher cervical --> C2-3
- stable
flex:
- lower cervical
- unstable
211
differentiate: flexion vs extension teardrop fx --> lat XR --> appearance?
ext:
- antinf avulsion frgmt
- no sublux
- spinolaminar line intact
flex:
- antinf avulsion frgmt
- sublux
- spinolaminar line disrupt
212
what is bilat interfacetal dislocation (bilat locked facets)? MOA? MC location?
hyperflex --> lower cervical --> all spinal lig --> complete disrupt --> vertebra --> ant dislocate --> >50%
213
perched facet --> how much ant sublux --> measuremt?
>3mm, but less than 50%
214
what is naked facet sign?
sup articular facet --> not covered by adj inf facet
215
differentiate --> bilat vs unilat locked facet --> stability?
bilat --> unstable
unilat --> stable
216
what is Grisel synd? MC etiology?
pharyngitis/retropharyngeal mass --> inflamm mass --> C1-C2 --> rotatory subluxation
217
AC jt injury --> epidemiology? MOA?
YA athlete --> lat shoulder --> downward blow
218
AC jt space --> normal measuremt?
<5mm
219
coracoclavicular jt space --> normal measuremt?
<11-13mm
220
bilat --> AC & coracoclavicular jt --> asymm of how much is abnormal?
>50%
221
AC jt injury --> grading system?
- grade I: AC lig sprain --> normal XR
- II: AC disrupt, CC intact
- III: AC + CC disrupt
- IV: distal clavicle --> post displace
- V: severe grade 3 --> >100% displace
- VI: distal clavicle --> inf displace
222
what is Hill-Sachs lesion? location?
humeral head --> postlat aspect --> compression fx
223
Hill-Sachs lesion --> XR --> best seen on what view?
AP --> int rot
224
what is Bankart --> lesion vs bony? location?
glenoid --> ant-inf rim:
- lesion --> labrum only (+ periosteum)
- bony --> fx
225
shoulder --> post dislocation --> etiology?
severe muscle spasm:
- sz
- electrocute
226
post shoulder dislocate --> XR --> best seen on what view?
transscapular Y
227
post shoulder dislocate --> XR --> Grashey view --> appearance?
humeral head --> overlap w glenoid
228
post shoulder dislocate --> 2 signs?
- lightbulb sign --> fixed int rot --> humeral head appearance
- trough sign (reverse Hill-sachs) --> humeral head --> antmed aspect --> compression fx
229
inf shoulder dislocate (luxatio erecta) --> assoc injuries? (2)
- rotator cuff tear
| - grter tuberosity fx
230
inf shoulder dislocate (luxatio erecta) --> potential comp?
axillary nerve/art injury
231
inject fluid --> glenohumeral jt --> extend into subacromial/subdeltoid bursa --> dx?
complete rot cuff tear
232
shoulder impingemt synd --> clinical or imaging dx?
clinical
233
shoulder impingemt synd --> extrnsic impingmt --> 2 types? which is MC?
- #1 primary external impingemt
| - subcoracoid impingemt
234
shoulder impingemt synd --> extrnsic impingmt --> primary external subtype --> MOA?
coracoacromial arch --> variant anatomy:
- subacromial enthesophyte
- hooked acromion
- AC jt osteophyte
- os acromiale
- thick corocoacromial lig
235
shoulder impingemt synd --> extrnsic impingmt --> primary external subtype --> epidemiology?
young athlete --> repetitive overhead mvmt (throwing)
236
shoulder impingemt synd --> extrnsic impingmt --> primary external subtype --> chronic --> comp?
- supraspin tendon +/- long head biceps tendon --> degen/tear
- subacromial/subdeltoid bursitis
237
shoulder impingemt synd --> extrnsic impingmt --> subcoracoid impingemt subtype --> MOA?
narrow coracohumeral distance
238
shoulder impingemt synd --> intrnsic impingmt --> MOA?
rot cuff/jt capsule --> abnormality --> glenohumeral instable
239
os acromiale --> can be asympt --> what imaging finding suggests os may be cause of pain?
BM edema
240
os acromiale --> tx?
- resect
| - fuse
241
rot cuff --> 4 componts?
- supraspin
- infraspin
- teres min
- subscap
242
rot cuff --> which insert on grter tuberosity? lesser?
grter:
- supraspin
- infraspin
- teres min
lesser:
- subscap
243
rot cuff --> what is "footprint"?
attachmt of tendons at grter tuberosity
244
rot cuff --> what is "critical zone"?
supraspin tendon --> 1cm prox to insertion site --> potentially undervascularized --> predispose to rupture
245
rot cuff --> 2 MC injured compont? least?
```
#1 supraspin
#2 infraspin
```
least --> teres min
246
rot cuff --> partial tear --> 3 types? MC?
- #1 articular surface
- bursal surface
- intrasubstance
247
rot cuff --> what is "rim rent" tear?
aka partial thickness articular supraspin tendon avulsion (PASTA) lesion:
supraspin --> insertion site --> articular surface --> avulsion --> partial tear
248
rot cuff --> what is "PAINT" lesion?
partial articular tear w intratendinous extension: PASTA/rim rent tear --> tear extend into tendon
249
supraspin tear --> 1/3 assoc other injuries? (2)
- infraspin tear
| - biceps tendon injury
250
RA --> rot cuff complete tear --> chronic --> classic appearance?
humeral head --> migrate sup --> may articulate w acromion
251
rot cuff --> full thick tear --> how classified?
length of affected tendon:
- <1cm small
- >5cm massive
252
rot cuff atrophy --> MCC? less common cause?
- #1 chronic rot cuff tear
less common --> denervation
253
rot cuff tear --> fatty degen --> how long after injury? reversible or irrev?
4wk --> irrev
254
rot cuff --> fatty infilt --> assess on which plane?
sag
255
rot cuff --> fatty infilt --> classification system?
Goutallier classification
256
Goutallier classification?
- grade 0: normal, no fat
- 1: few fat streaks
- 2: muscle > fat
- 3: muscle = fat
- 4: msucle < fat
257
denervation --> rot cuff atrophy --> assoc finding?
paralabral cyst
258
what is adhesive capsulitis (frozen shoulder)?
jt capsule & synovium --> inflamm --> jt capsule thick & contract
259
adhesive capsulitis (frozen shoulder) --> clinical or imaging dx?
clinical
260
adhesive capsulitis (frozen shoulder) --> MRI finding? (2) measuremt?
- jt capsule & synovium --> thick >4mm
| - rot cuff interval --> loss of fat
261
shoulder --> what is rotator interval?
bw supraspin & subscap tendons --> triangle region --> allow rotation mvmt around coracoid
262
shoulder --> rotator interval --> contains what 3 struct?
- coracohumeral lig
- long head biceps tendon
- sup glenohumeral lig
263
3 glenohumeral lig?
- sup
- middle
- inf
264
coracohumeral lig --> attachmts?
- coracoid process
| - humerus --> grter tubercle
265
"biceps pulley" --> 3 compnts?
- sup glenohumeral lig
- coracohumeral lig
- supraspin tendon
266
coracohumeral lig --> location --> internal or ext to jt capsule?
ext
267
sup glenohumeral lig --> attachmts?
- scapula --> supraglenoid tubercle-
| - humerus --> lesser tuberosity
268
middle glenohumeral lig --> attachmts?
- scapula --> supraglenoid tubercle-
| - humerus --> lesser tuberosity
269
middle glenohumeral lig --> congenitally absent --> what % of pts?
1/3
270
middle glenohumeral lig --> tear --> assoc other injury?
sup labrum tear
271
inf glenohumeral lig --> attachmts?
- humerus --> anatomic neck
| - inf glenoid labrum
272
inf glenohumeral lig --> 3 compnts?
- ant band
- axillary pouch
- post band
273
capsulolabral complex --> abduction & ext rot stability --> #1 important compnt?
inf glenohumeral lig
274
long head biceps tendon --> attachmt?
antsup glenoid rim
275
long head biceps tendon --> fluid in tendon sheath --> can be normal --> why?
biceps tendon sheath --> comm w glenohumeral jt
276
what is biceps pulley? fx?
bicipital groove --> capsuloligamentous complex --> sling --> stabliize biceps tendon
277
biceps tendon sublux --> definition?
tendon --> bicipital groove --> displaced from, but still in contact w
278
biceps tendon sublux/dislocation --> assoc other injury?
transverse lig injury
279
transverse humeral lig --> attachmts?
- grter tuberosity
| - lesser tuberosity
280
biceps tendon dislocation --> assoc other 2 injuries in conjunction?
- transverse lig
| - biceps pulley
281
biceps tendon --> medial dislocation --> assoc other injury?
subscap tendon tear
282
what is shoulder instability?
mv --> humeral head --> abnormal motion relative to glenoid
283
shoulder instability --> 3 manifestations?
- dislocate
- sublux
- microinstable
284
glenohumeral jt --> soft tissue stabilizers --> dynamic componts? (2)
- rot cuff
| - biceps tendon
285
glenohumeral jt --> soft tissue stabilizers --> static componts? (4)
capsulo-labro-lig complex:
- bony glenoid fossa
- labrum
- coracohumeral lig
- sup/mid/inf glenohumeral lig
286
glenohumeral jt --> traumatic instability --> aka?
TUBS:
- traumatic
- unidirectional
- Bankart
- surgical
287
glenohumeral jt --> atraumatic instability --> 2 types?
AIOS:
- acquired
- instability
- overstress
- surgery
AMBRI:
- atraumatic
- multidirectional
- bilat
- rehab
- inf capsule shift
288
glenohumeral jt --> atraumatic instability --> AIOS subtype --> epidemiology? MOA?
athlete --> repetitive mvmt
289
glenohumeral jt --> atraumatic instability --> AMBRI subtype --> etiology?
congenital jt lax
290
shoulder --> labral injury --> how to describe location of injury? (2)
- clock
| - sextant
291
shoulder --> what is sublabral foramen?
10% --> normal variant --> labrum --> antsup segmt --> not attached to bony glenoid
292
shoulder --> what is Buford complex?
6. 5% --> normal variant:
- labrum --> antsup segmt --> absent
- middle glenohumeral lig --> thick cord-like
293
shoulder instability lesions --> MC location?
- antinf aspect of glenohumeral jt
| - assoc w ant band of inf glenohumeral lig
294
what is glenoid labrum ovoid mass (GLOM) sign?
ant labrum --> tear --> retract sup --> dark ovoid mass ant to labrum
295
MRI --> shoulder --> intra-articular --> black mass --> ddx? (3)
- GLOM sign
- dislocated biceps tendon
- air bubble
296
bony Bankart --> RF for what?
glenoid insuff --> recurrent dislocate
297
what is ant labro-lig periosteal sleeve avulsion (ALPSA)?
Bankart lesion --> but intact periosteum
298
ant labro-lig periosteal sleeve avulsion (ALPSA) --> balled-up labrum --> displaces to what location?
inf-med
299
what is Perthes lesion?
labrum --> antinf avulsion --> remain attached to periosteum
300
Perthes lesion --> best imaging modality? best positioning?
MR arthrography --> abd-ext rot (ABER)
301
what is humeral avulsion of inf glenohumeral lig (HAGL)?
inf glenohum lig --> humeral attachmt --> avulsion
302
humeral avulsion of inf glenohumeral lig (HAGL) --> assoc other injury?
subscap tendon tear
303
what is bony humeral avulsion of inf glenohumeral lig (BHAGL)?
HAGL + humerus --> anatomic neck --> bony avulsion
304
shoulder --> post instability --> assoc other injuries? (2)
- infraspin
| - teres minor
305
shoulder --> post instability --> a congenital cause?
hypoplastic post glenoid
306
what is Bennett lesion (thrower's exostosis)?
inf glenohumeral lig --> post band --> avulsion --> extra-articular posterior ossification
307
Bennett lesion (thrower's exostosis) --> epidemiology?
baseball pitcher
308
what is sup labrum ant post (SLAP) tear?
biceps tendon attachmt --> sup labrum --> tear --> ant-post orient
309
sup labrum ant post (SLAP) tear --> MC type? MC etiology?
type II
repetitive microtrauma
310
sup labrum ant post (SLAP) tear --> 4 types?
- type I: sup labrum --> fray
- II: I + stripped
- III: bucket handle tear
- IV: III --> extend into biceps tendon
311
what is glenoid labral articular disruption (GLAD)?
- antinf labrum --> superficial tear
| - adj glenoid articular cartilage injury
312
glenoid labral articular disruption (GLAD) --> assoc w shoulder instability --> T/F
F
313
glenoid labral articular disruption (GLAD) --> potential comp?
post-trauma arthritis --> intra-art bodies
314
labral tear --> specific finding?
paralabral cyst
315
paralabral cyst --> potential comp?
compress nerve --> entrapmt neuropathy
316
quadrilateral space --> location? boundaries?
axilla -> post aspect:
- humerus
- long head triceps
- teres minor
- teres major
317
quadrilateral space --> contains what N & A?
- axillary N
| - post humeral circumflex A
318
what is quadrilateral space synd?
quad space --> axillary N entrap --> teres minor +/- deltoid --> paresthesia --> atrophy
319
suprascapular notch --> contains what N & A?
prox suprascap N & A
320
suprascapular notch --> prox suprascap N --> entrap --> what muscles affected?
- supraspin
| - infraspin
321
suprascapular notch --> prox suprascap N --> entrap --> MCC?
sup labral tear --> paralabral cyst
322
spinoglenoid notch --> what N?
distal suprascap N
323
spinoglenoid notch --> distal suprascap N entrap --> what muscle affected?
infraspin
324
what is Parsonage-Turner synd?
idiopathic brachial neuropathy --> rot cuff atrophy
325
Parsonage-Turner synd --> how dx?
dx of exclusion --> 1st r/o structure causes for atrophy --> ie mass/cyst compress N
326
elbow dislocation --> MC type?
radius + ulna --> post dislocate
327
XR --> elbow dislocation --> next step? why?
XR forearm --> look for ulna fx
328
XR elbow --> fat pad sign --> no identifiable fx --> next step?
- XR --> additional views --> radial head
| - CT
329
what is Essex-Lopresti fx-dislocation?
- radial head fx
| - tear interosseous membrane --> distal radioulnar jt --> ulna dislocation
330
what is Monteggia fx-dislocation?
- ulna fx
| - elbow --> radius dislocate
331
what is Galeazzi fx-dislocation?
- radius fx --> distal 1/3
| - distal radioulnar jt --> ulna dislocate
332
Colles fx --> usu intra-art extension --> T/F?
T
333
what is Hutchinson (chauffer's) fx?
distal radius --> radial aspect --> fx --> extend to radial styloid & radiocarpal jt
334
what is perilunate dislocation?
capitate --> dislocate from lunate
335
what is lunate dislocation?
lunate --> dislocate volar
336
scapholunate advanced collapse (SLAC) --> etiology? (3)
- OA
- CPPD arthropathy
- chronic untreated scapholunate dissociation
337
scapholunate lig injury --> sign?
Terry Thomas sign
338
what is scapholunate advanced collapse (SLAC)?
sequela of chronic scapholunate lig injury
339
Kienbock dz --> assoc other finding?
neg ulnar variance (ulna shorter than radius)
340
Kienbock dz --> MOA?
inc load on lunate
341
mallet finger --> MOA?
direct impact --> tip of finger --> DIP --> disrupt extensor tendon
342
Boutounniere deformity --> MOA?
PIP --> extensor tendon --> medial slip --> injury --> PIP jt herniate thru --> become entrapped
343
Boutounniere deformity --> etiology? (2)
- #1 RA
| - trauma
344
what is gamekeeper's (skier's) thumb? MOA?
force abduct --> thumb --> prox phalanx base --> ulnar collateral lig --> injury
345
differentiate: ulnar collateral lig --> tear --> incomplete vs complete --> tx?
- incomplete --> conservative
| - complete --> surg
346
ulnar collateral lig tear --> potential comp?
Stener lesion:
- UCL injury
- adductor aponeurosis interposition
347
Stener lesion --> tx?
surg
348
what is Bennett fx?
1st metacarpal base --> fx --> intra-articular
349
what is Rolando fx?
Bennett fx --> comminuted
350
what is Boxer's fx?
metacarpal neck fx (usu 5th metacarpal)
351
what is volar plate fx? MOA?
hyperextend --> middle phalanx --> proximal --> volar aspect --> fx
352
carpal tunnel --> contains what struct? (10)
- 4 flexor dig profundus
- 4 flexor dig superficialis
- 1 flexor pollicis longus
- 1 median N
353
lister's tubercle --> can cause rupture of what tendon?
3rd extensor tendon (EPL)
354
carpal tunnel synd --> assoc w diaysis --> T/F?
T
355
carpal tunnel synd --> imaging finding --> bowing of what struct?
flexor retinaculum
356
extensor carpi ulnaris --> dislocate --> med or lat?
med
357
Bennett fx --> metacarpal base fx --> dorsolat displace --> what tendon is involved?
abd pollicis longus
358
gamekeeper's/skier thumb --> what tendon is involved?
ulnar collateral lig
359
gamekeeper's/skier thumb --> comp?
stenor lesion
360
what is stenor lesion?
ulnar collateral lig --> torn --> adductor tendon aponeurosis --> get caught in torn edge
361
stenor lesion --> classic "sign"
yoyo on a string
362
stenosing tenosynovitis (trigger finger) --> imaging finding?
thick tendon sheath
363
cubital tunnel synd --> MCC?
accessory anconeus (anconeus epitrocholearis)
364
lat epicondylitis --> aka? MOA?
tennis elbow --> repetitive extend
365
med epicondylitis --> aka? MOA?
golf elbow --> repetitive flex
366
elbow --> partial ulnar collateral lig tear --> imaging sign?
T sign --> contrast medial extend medial to medial coronoid (sublime tubercle)
367
elbow --> ulnar collateral lig --> composed of 3 lig --> which is most important?
ant bundle
368
elbow --> partial ulnar collateral lig tear --> epidemiology? MOA?
thrower --> valgus overload
369
thrower --> elbow --> valgus overload synd --> synd? (3)
- ulnar collateral lig injury --> usu ant band
- post humerus/ulna arthritis
- capitellum OCD
370
what is little leaguer elbow?
throw --> repetitive chronic microinjury --> medial epicondyle apophysis:
- stress fx
- avulsion
- delayed closure
371
little leaguer elbow --> other assoc injury?
ulnar collateral lig injury
372
epitrochlear LAD --> ddx? (1)
cat scratch dz
373
partial biceps tear --> assoc condition?
bicipitoradial bursitis
374
triceps rupture --> assoc other injury?
Salter Harris 2 fx of olecranon
375
reverse shoulder arthroplasty --> indication? (2)
- proximal humerus fx --> 3-4 parts
| - rot cuff is trashed
376
reverse shoulder arthroplasty --> comp? (1)
excess deltoid tugging --> post acromion fx
377
rot cuff is trashed --> can get reverse shoulder arthroplasty --> requires what struct to be intact?
deltoid
378
ext shoulder impingemt --> subacromial --> involve which tendon?
supraspin
379
ext shoulder impingemt --> subcorocoid --> involve which tendon?
subscap
380
int shoulder impingemt --> postsup --> involve which tendon?
infraspin
381
rot cuff --> partial tear --> % tear for surgical intervention?
>50%
382
what is massive rot cuff tear?
tear of at least 2 of 4 rot cuff muscles
383
multidirectional glenohumeral instability --> glenohumeral vol --> dec/normal/inc?
inc
384
adhesive capsulitis (frozen shoulder) --> glenohumeral vol --> dec/normal/inc?
dec
385
SLAP --> assoc w instability --> T/F?
F
386
trauma --> foot in int rot --> what type of hip dislocation?
post hip dislocate
387
hip fx --> intracapsular --> degree of displacemt corresponds to risk of AVN --> T/F?
T
388
snapping hip synd --> etiology? (3) MC?
- #1 external --> iliotibial band over grter trochanter
- internal --> iliopsoas over iliopectineal eminence or femoral head
- intra-articular --> labral tear, loose bodies
389
snapping hip synd --> iliopsoas over iliopectineal eminence or femoral head (internal type) --> how to eval for?
US
390
hip --> labral tear --> MC type?
ant-sup
391
os acetabuli --> assoc conditions? (2)
- labral tear
| - femoroacetabular impingemt
392
Segond fx --> MOA?
int rot
393
reverse Segond fx --> fx of what struct?
medial tibial plateau
394
reverse Segond fx --> assoc other injuries? (2)
- PCL tear
| - medial meniscus injury
395
reverse Segond fx --> MOA?
ext rot
396
what is arcuate sign?
proximal fibula --> avulsion
397
arcuate sign --> assoc other injury? (1)
cruciate lig injury --> usu PCL
398
what is deep intercondylar notch sign?
impaction injury --> depression of lat femoral condyle
399
deep intercondylar notch sign --> assoc other injury?
ACL injury
400
ACL mucoid degen --> imaging sign? (2)
- T1 --> "drumstick"
| - T2/STIR --> "celery stick"
401
ACL mucoid degen --> comp?
ACL ganglion cyst
402
ACL repair --> clinical significance of...?
- femoral tunnel
- tibial tunnel
- femoral tunnel --> maintain isometry
| - tibial tunnel --> roof impingemt
403
ACL repair --> 16wk later --> extend knee --> palpable audible chunk --> dx?
arthrofibrosis
404
ACL repair --> arthrofibrosis --> imaging finding?
Hoffa's fat pad --> mass-like scar (cyclops lesion) --> low signal
405
ACL graft --> should be parallel to intercondylar notch --> if become more horizontal --> dx?
graft tear
406
fibular head edema --> ddx? (1)
post lat corner injury
407
patella tendon tear --> classic assoc condition?
SLE
408
bilat patella tendon tear --> classic predisposing factor?
chronic steroid
409
acute flat foot --> dx?
post tib tendon injury
410
ankle --> ATFL & tibfib lig injury --> lateral instability --> chronic synovial inflamm --> comp?
lat gutter --> mass of hypertrophic synovial tissue --> antlat impingemt synd
411
ankle --> antlat impingemt synd --> MRI finding?
lat gutter --> "meniscoid mass" (balled up scar) --> T1/T2 dark
412
tarsal tunnel --> general location?
behind med malleolus
413
tarsal tunnel synd --> involved N? distribution of pain?
post tib N --> 1st 3 toes
414
tarsal tunnel --> covered by what struct?
flexor retinaculum
415
tarsal tunnel --> contains what struct? (5)
- post tib A & N
- tib post ("tom")
- flex dig long ("dick")
- flex hallicus long ("harry")
416
morton neuroma --> is it a neuroma or scar?
scar
417
ballet dancer --> what condition?
os trigonum synd
418
calcaneal tuberosity avulsion --> underlying condition?
DM
419
achilles tendon rupture but can still plantarflex --> dx?
plantaris rupture (tennis leg)
420
plantaris rupture (tennis leg) --> imaging appearance?
fluid collection bw soleus & med head of gastroc
421
what is spring ligament?
group of calcaneonavicular ligaments
422
what is deltoid ligament?
complex of medial collateral ligaments of ankle
