3.2 MSK Pathology Flashcards
Name the 7 Pathologies we cover in MSK?
- Tears
- Inflammation (tendonitits/peritenditis)
- Ganglion Cysts
- Popliteal/Bakers cyst
- Carpal Tunnel Syndrome
- Tumours
- Foreign bodies
4 factors that contribute to a tendon tear? (weakening of tendon)
Age
Calcification
Corticosterioids (commonly used to treat inflamm)
Systemic diseases (arthritis, DM, Lupus, gout)
What are the 2 different types of tendon tears?
Complete (often clinical diagnosis, may not need US)
Incomplete (tendinitis symptoms)
What are complete tears?
Torn all the way in half
gap/defect can be of variable length
What are incomplete tears?
Focal defect of tendon attachment, partially torn.
Tendon tears are sonographically variable name 6 things it could have.
- Hypoechoic defects ( watch for anisotrophy)
- Focal thinning
- Architectural distortion (fibers look distorted)
- Fluid filled defects
- Echogenic deposits if chronic
- Possible non-visualization of tendon
Rotator Cuff Sonographic Complete tear appearance
Deltoid sits directly on humerus head (normally deltoid, supraspinatus, HH)
CARTILIAGE INTERFACE sign
What is the cartilage interface sign
Thin, hyperechoic line at interface between normally hypoechoic cartilage and the ABNORMALLY hypoechoic tendon
Rotator Cuff Sonographic small incomplete tear appearance
Rim Rent Sign
What is the Rim Rent Sign?
Comma shaped, focal abnormal echogenicity within the tendon
Rotator Cuff Tear Sonographic Associated sign
Join effusion (fluid in joint space) Irregularity of bony surface (GT area) Geyser sign (collection fluid superior to AC joint)
Inflammation of the tendon is known as
Tendonitis
Tendonitis is often___ or ___ related
sport or work
Inflammation of the tendon can be___ or ___
Diffuse or focal
Inflammation can present with what 2 things?
Edema of tissue or
calcifications if chronic
What is the hallmark feature of tendonitis?
TENDON THICKENING
compare to contralateral side
Tendonitis sonographically
decrease echogenicity (watch technique) Hypermia (increased blood flow, usually poor Blood supply ) Possible calcifications (chronic)
3 other inflammation of tendons ?
- Peritendinitis
- Tenosynovitis
- Bursitis
What is peritendinitis?
inflammation to the CT that surrounds the achilles
What is Tenosynovitis?
inflammation of the tendon sheath (fibrous sheath surrounding many other tendons in body)
What is Bursitis?
Inflammation of a Bursa
often due to trauma or microtrauma
Sonolucent collection with ill-defined walls
What are ganglion cysts?
Benign soft tissue tumor typically in hand or wrist
palpable mass, focal pain
What are ganglion cysts sonographic appearance ?
Cystic mass attached to tendon sheath
oval fluid collection with enhancement
may contain debris
Chronic may have more hypoechoic solid appearance
Popliteal cyst is known as a?
Bakers cyst (Synovial cyst of the knee, pop fossa)
The popliteal cyst is a dilated
Dilated
The popliteal cyst is located?
Posteromedial
The popliteal cyst is associated with
Rheumatoid arthritis
The popliteal cyst can be ___ or ____
Symptomatic (can mimic DVT or thrombophlrbitis) or Asymptomatic
The popliteal cyst have the potential to ?
rupture and dissect down the calf
What is encroachment of the medial nerve?
CARPEL TUNNEL SYNDROME
Carpel tunnel can be a result of which 2 things?
Decrease in tunnel size
Increase in volume within the space
What will the patient present with, with carpel tunnel syndrome?
Pins and needles
Does US usually diagnosis Carpel tunnel? Y or N
No
No the best way.. but Carpel tunnel imaging signs include(4)
- a nerve that is 3x bigger in one axis than another axis 90 degrees
- loss of honeycomb appearance in SAX
- Increase or decrease in countour/size LAX
Increase in cross-section area when compared to other side
What are 3 Benign tumors in MSK?
- Giant cell tumors
- Osteochondroma
- Lipoma
Giant cell tumors are?
Benign tendon sheath tumors
Giant cell tumors sonographically (2)
Hypoechoic masses with lobulated contour
Osteochondroma are?
Benign cartilaginous tumors, can develop in a popliteal cyst
Osteochondroma sonographically (2)
Hyperechoic area with posterior shadowing
Lipomas are?
Tumors compossed of fat or adipose tissue
compressible, mobile and painless
Lipomas sonographically (2)
Often hyperechoic but depends on surrounding tissue
US used to Identify nonradio or radio-opaque Foreign Bodies, this means ?
They Do not show up on x ray (nonradio)
or do show up on US (radio) but want more info with US on where it is located.
Soft tissue can be examined for _______ inflammatory changes (like abscess)
secondary
Metal Foreign Bodies sonographically (2)
Hyperehcoic Comet tail (metal)
Foreign Bodies Can be (3)
Metal, splinter or glass
US can be used for guidance.
