Flashcards in Pathology Deck (62):
Describe a tendon
A Tendon is composed of parallel running fascicles of collagen fibres which interweave and interconnect producing an echogenicity fibrillation pattern on ultrasound in the longitudinal plane. They are the insertion all portions of muscles.
They are located close to honey landmarks .
They are subject to anisitrophy .
Giant cell tumour
Preferentially involves the first 3 fingers and first 2 toes.
Slow growing, benign
Arises from synovium of tendon sheaths and dan cause bone erosions
On U/S appear as well defined solid homogenous , hypoechoic masses encircling the tendon.
Do not move with tendon
Nerve entrapment Syndrome
Nerve swelling is typically is typically fusiform
The nerve may become uniformally hypoechoic with loss of the fascicular pattern at the level of the compression site and proximal to it.
U/S can demonstrate changes in nerve shape and echotexture.
What is Rheumatoid Arthritis?
An autoimmune disease
A chronic inflammatory joint disease which principally affects synovial joints.
Inflammatory response leads to excessive synovial fluid being formed and joint swelling. Pan us ( fibrous tissue) may be formed in the synovium. The disease process often leads to destruction of the articular cartilage and ankylosis ( fusion) of the joints.
Marginal bony erosions which U/S can visualise much earlier than X-ray
Nodules in periarticular soft tissues of fingers
What is a lipoma?
A lipoma is an encapsulated benign fatty tumour. Often found in the the superficial layers between skin and muscle.
What is tendonopathy?
Tendonopathy is a general term for a diseased tendon, where tendons appear heterogenous and dissimilar to the contra lateral side.
What is tendonosis
Tendonosis is mucous degeneration of a tendon from chronic repetitive tendon loading.
Disruption of the collagen microfibrils and a progressive accumulation of extracellular tendon matrix leads to swelling and weakening of the tendon.
Chronic tendinosis can lead to tendon rupture.
Gradual pain with pain and stiffness in the morning which diminishes with exercise.
U/S hypoechoic fusiform or focal thickening of tendon with the fribrillar texture of the tendon discernable.
What is tenosynovitis?
Tenosynovitis is a response of the synovial sheath to inflammation where an excess of synovium is produced.
May mimic a ganglion
U/S anechoic or hypoechoic fluid around the tendon.
Tendons may be echogenic and thickened.
Chronic tenosynovitis will demonstrate vascularity, while acute will not.
What is stenosing tenosynovitis?
Occurs when a tendon affected by tenosynovitis becomes constricted and trapped within a fibro-osseous canal or beneath a ligament
U/S bunching of a thickened tendon at the level of the ligament, retinaculum or pulley eg de Quervains
What is septic tenosynovitis?
This can mimic a septic joint.
U/S extensive hypoechoic tenosynovitis.
Fluid may be heterogenous and compartmentalised
What is paratendinitits/ peritendinitis?
Occurs in tendons without a synovial sheath, ie Achilles Tendon.
Oedema occurs in the paratenon surrounding the tendon.
U/S tendon may be normal with a hypoechoic layer surrounding the tendon.
Hyperaemia may be present
Hyperaemia describes increased vascularity.
Normal Tendons do not display vascularity.
U/S light pressure and relaxed tendon.
What is enthesopathy?
A disease of the bony insertion at the site of the tendon attachments.
U/S bony irregularities with loss of continuity of the insertion all fibres
What is synovitis?
An inflammatory condition of the synovial membrane of a joint or tendon. Fluid accumulates around the capsule:the joint/sheath is swollen, tender and painful. Motion may be restricted.
May be hyperaemic
What is bursitis?
Is an inflammation of the the bursa from repeated or a single episode of trauma.
The bursa becomes filled with serous fluid or blood.
Stretching of the small nerve fibres within a thickened bursa causes pain with movement.
U/S hypoechoic thickening of the distended bursa compare with contra lateral side
Describe a strain
A strain of a muscle is usually post traumatic with pain and sometimes swelling of the affected area.
U/S focal area of increased echogenicity in a muscle
What is a partial tear?
A partial tear can appear similar to tendinosis but the fribrillar pattern is lost.
Sudden onset of pain, little morning soreness and pain with increased activity
U/S hypo or anechoic cleft adjacent to one surface or tendon of tendon or muscle.
Describe an intrasubstance tear
An intrasubstance tear is a tear within a tendon or muscle which does not extend to either surface.
U/S hypo or anechoic cleft in the mid substance of a tendon or muscle
A longitudinal tear is a split along the tendon
U/S tendon thickening with a hypoechoic split in the tendon
What is a tenodeses?
This is a surgical term where a tendon is stapled to the bone
U/S shows a thin tendon applied close to the bone
Describe a full thickness tear?
Is a tear which extends through both surfaces of the tendon or muscle.
U/S hypo or anechoic cleft which extends to both surfaces of the tendon or muscle.
Describe a complete tear
This is a full thickness tear which not only extends through the depth of the tendon but also a substantial tear through the width of the tendon.
U\S non visualisation of the tendon
Rupture implies the abscence of a tendon. The proximal and distal ends of the tendon may recoil and over lap appearing bulbous or lax with a wavy fibrillar pattern.
A palpable lump may sometimes be retracted muscle or tendon in the case of a rupture .
U/S abscence of a tendon in its normal position.
Haemorrhage may replace the tendon.
Measure the distance between the two tendon ends
What is subluxation?
Is the abnormal movement of a tendon out of ots natural resting place either due to a congenitally shallow bony groove or due to rupture of the retinaculum or ligament out of its natural location, usually a bony groove.
U/S dynamic scanning shows the tendon snapping in and out of its natural location.
Persistent abnormal location of a tendon out of its bony groove due to trauma or rupture of the retinaculum or ligament holding itin place
U/S tendon not visible in its natural location.
U/S tendon not visible in its natural location. A dislocated tendon can be mistaken for a ruptured tendon. Scan the musculotendinous junction and follow the tendon in transverse to confirm its presence and abnormal location
What is a joint effusion?
Occurs with inflammation of the joint and it's surrounding capsule
U/S simple joint effusion appears anechoic
Complex heterogenous joint effusion -infection, Inflammatory conditions, haemorrhage, intra-articular, pigmented Villonodular synovitis, synovial osteochondromatosis
What is synovial proliferation and Pannus?
Is a thickening of the synovium in a bursa associated with arthritis and chronic infections
U/S echogenic lobular nodules within a distended bursa with or without increased colour flow
What is a neuroma?
A neuroma is a benign mass of peri neural fibrosis affecting nerves
U/S fusiform hypoechoic swelling of a nerve
What is a neurilemmonas/Schwannoma?
A benign tumour of the nerve Schwann cells.
May contain cystic spaces and sit outside the fascicles and can therefore be removed
U/S exophytic swelling
What is a ganglion?
It is a benign cystic lesion arising from the joint or tendon sheath.
They can be multiliculated or simple and may contain debris.
Look for a neck
They may be palpable
They may compress nerves causing neuropathic symptoms
Comment on their relationship to vessels, tendons and joints
U/S hypo or anechoic lesion adjacent to a joint or synovial sheath.
Comment on their relationship to vessels, tendons and nerves
What is inflammation?
A physiological response of the body to tissue injury, includes dilation of blood vessels and an increase in vessel permeability
What is hyperaemia?
Describes increased vascularity.
Normal tendons do not demonstrate any vascularity.
U/S light pressure and a relaxed tendon are imperative when assessing for increased flow
What is entrapment syndrome?
This occurs when the PIN gets trapped between the supination muscles at the Arcade of Froshe
What is pronator syndrome
Entrapment of the median nerve between the 2 heads of the pronator Teres muscles.
What is compartments syndrome?
This occurs when there is insufficient blood supply to muscles and nerves due to increased pressure within one of the bodies compartments.
Often presents with parathesia ( pins and needles)
Tough walls of the fascia cannot easily expand and compartment pressure rises.
Usually due to fractures
What is cubital tunnel syndrome?
This occurs when the Ulna N is compressed or irritated in the cubital tunnel
Describe an effusion
The presence of increased intra-articular fluid. It may affect the joint caused by inflammation, infection or trauma and may be exudate, blood or fat
What is pigmented Villonodular Synovitis
A joint disease characterised by inflammation and overgrowth of the joint lining.
Commonly hip and knee.
The overgrowth of synovium harms the bone next to the joint. The lining also makes extra fluid that can cause swelling and makes movement painful.
Frictional inflammation occurring at the site where APL and EPB cross ECRB and ECRL in the distal forearm.
Thickening of tendons seen. Compare with contra lateral side.
There is no synovial sheath in this region thus no fluid will be seen on U/S
What is a Mallet finger ?
rupture of the distal extensor tendon at the DIPJ producing a flex ion deformity, clinically there will be no active extension, though passive extension may be formed
If left untreated for a prolonged period hyper extension of the DIPJ develops because of hyper laxity of the PIPJ the resulting deformity is called a swan neck deformity.
Injury of the central slip of extensor tendon at the PIPJ and prolapse of the lateral bands causing flexion of the PIPJ and hyper extension of the DIPJ can result in capsular contraction and boutonnière deformity.
Closed trauma with acute forceful flexion of the PIPJ
Explain extensor hood injuries?
Painful subluxation of the extensor tendon due to disruption of the extensor hood usually at the MCPJ of the 3rd or 4th finger
What is Trigger finger?
This is when the digit locks in flexion
Thickening of the flexor tendon which gets caught under the A1 pulley
Pulley may appear thickened
What is Jersey finger?
Avulsion of the FDP usually of the ring finger
Can rupture distally and retract to palm level
Or an avulsed fragment of the distal phalanx will retract to the proximal IPJ level
Or the avulsed fragment of the distal phalanx remains at the distal IP level.
What is climbers finger
Flexor tendon pulley rupture
Bow stringing of the flexor tendon during restricted contraction
What is skiers thumb
Injury to the UCL of the 1st MCPJ during forces abduction
What are Dupuytres contractures?
These are caused by fibrosis of the palmar aponeurosis .
They appear hypoechoic.
What is hypothenar hammer syndrome?
Caused by repetitive trauma to the hypothenar eminence .
This may cause spasm, aneurysm or thrombosis of the ulna artery causing ischaemia of the hand and fingers.
Can use Tinels and Allens tests
What is synovial sarcoma?
Slow growing soft tissue mass
Most common location is in soft tissues adjacent to large joints eg knee and pop fossa
They do not arise fro synovial structures
U/S non specific heterogenous, hypoechoic mass.
What is a granuloma?
Granuloma form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate
The four major components for tendinosis are?
1. tenocyte damage
2. Collagen disruption ( on U/S the white bits are disrupted)
3. Increased ground substance ( the black bits are bigger-this can be focal or diffuse)
4. Neuro/angiogenesis ( colour flow is seen)
What is a Pilomatricoma?
-benign superficial tumour of the hair follicle
- usually children <10 years.
U/S- hyperechoic relative to muscle with posterior acoustic shadowing, ovoid or spherical, well defined, posterior enhancement and extension to dermis
What is a sebaceous cyst?
Limited to dorsal surface where sebaceous glands are present
Cellulitis or panniculitis is usually caused by streptococcus or staphylococcus
U/s- ill defined hyperechoic appearance of fat with blurring tissue planes, progressing to hypoechoic strands of oedema
Often with hyper vascularity.
On U/S- hyperechoic focus containing hypoechoic spaces related to infarcted fat
What is a delamination tear?
A horizontal retraction of either the bursal or articular surface of the tendon
What is neiva neovascularisation ?
The formation of functional microvascular networks with red blood cell perfusion in tissues not normally containing them
What is a arthropathy?
A disease or an abnormality of the joint
Results from the build up of calcium in body tissue. Overtime the buildup can harden and disrupt normal bodily processes.
When the tissue is damaged the body responds to this injury in a nonspecific manner by invoking a generic inflammatory response reaction. This sometimes results in calcification of damaged tissue.
Refers to the deposition if calcium
Degenerative joint disease
Includes disorders which cause defects in the integrity of the articular cartilage and related changes in the underlying bone and joint margins.
-initially changes occur in the articular cartilage with oedema followed by fibrillation and superficial and deep clefts possibly evolving towards ulcerations and the production of new cartilage and bone
-in severe forms complete cartilage lists associated with subchondral bone changes and marginal osteophytes can occur.
U/S- joint surface and hyaline cartilage abnormalities