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AJT CORE > CORE - MSK > Flashcards

CORE - MSK Flashcards

1
Q

Widened intercondylar notch + epiphyseal overgrowth (knee)

A

hemophilia, JIA

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2
Q

Kummel disease

A

gas in a vertebral body compression fracture; represents osteonecrosis

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3
Q

Shoulder arthrogram needle location

A

inferior-medial humeral head (at the GH joint)

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4
Q

Hip arthrogram needle location

A

lateral femoral head (at head-neck junction)

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5
Q

Posterior hip dislocation on AP radiograph

A

femoral head displaced superiorly and slightly lateral (in addition to posteriorly)

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6
Q

Anterior hip dislocation on AP radiograph

A

femoral head displaced inferiorly (most commonly); lesser trochanter is also more visible due to external rotation

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7
Q

Osteitis condensans ilii

A

benign sclerosis of the ilium adjacent to the SI joints; typically bilateral, triangular shape, joint space is normal

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8
Q

Hereditary hyperphosphatasia

A

a.k.a. juvenile Paget’s; AR; affects infants/toddlers; diffuse involvement of all bones

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9
Q

Osteopoikolosis

A

AD; periarticular; mild arthralgias, increased keloid formation

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10
Q

Spontaneous pneumothorax in an osteosarcoma patient

A

lung metastasis

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11
Q

Fracture healing time (general + fastest/slowest)

A

6-8 weeks generally; phalanges heal in 3 weeks (fastest), tibia heals in 10 weeks (slowest)

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12
Q

Delayed union (fracture)

A

fracture not healed within twice as long as expected

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13
Q

Non-union (fracture)

A

fracture not healed within 6-9 months; not going to heal without intervention

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14
Q

Mal-union (fracture)

A

fracture healed in poor anatomic position

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15
Q

Risk factors for improper fracture healing

A

Vitamin D deficiency, gastric bypass patients

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16
Q

1st and 2nd most common carpal bone fractures

A

scaphoid > triquetral; 70% of scaphoid fractures occur at the waist

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17
Q

First sign of AVN in scaphoid fracture

A

sclerosis; proximal scaphoid fractures are most susceptible to AVN (T1 dark)

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18
Q

Most important band of scapholunate ligament for carpal stability

A

dorsal band

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19
Q

DISI deformity is associated with injury to what ligament

A

scapholunate ligament; lunate rotates dorsally with triquetrium; more common type of -ISI deformity

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20
Q

Degenerative changes of radioscaphoid joint

A

consider SLAC or SNAC

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21
Q

Causes of scapholunate ligament injury

A

FOOSH, osteoarthritis, CPPD; may progress to SLAC wrist

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22
Q

Measurement for scapholunate ligament injury

A

> 3 mm widening (worse with clenched fist view)

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23
Q

Perilunate dislocation association(s)

A

60% assoc. with scaphoid fracture; capitate dislocates dorsally

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24
Q

Midcarpal dissociation association(s)

A

lunotriquetral ligament injury, triquetral fracture; capitate dislocates dorsally, lunate rotates volar

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25
Q

Lunate dislocation association(s)

A

occurs with dorsal radiolunate ligament injury

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26
Q

Space of Poirier

A

interval between capitate and lunate with poor ligamentous support; assoc. with perilunate dislocation/instability

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27
Q

Lesser arc vs. greater arc injuries (wrist)

A

lesser arcs injuries are purely ligamentous, greater arc injuries are assoc. with fractures

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28
Q

VISI deformity is associated with injury to what ligament

A

lunotriquetral ligament; lunate rotates volarly with scaphoid; Ulnar-sided injury (TL lig.) is VISI (‘U’ sort of looks like ‘V’)

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29
Q

DISI and VISI scapholunate angles

A

VISI is <30 degrees, DISI is >60 degrees; normal is 30-60 degrees

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30
Q

Bennett vs. Rolando fractures

A

Rolando is comminuted; both involve base of 1st metatarsal

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31
Q

Cause of dorsolateral dislocation in Bennett fracture

A

pull of abductor pollicus longus (APL) tendon

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32
Q

Stener lesion

A

occurs in Gamekeeper’s thumb; adductor pollicus tendon gets caught in torn UCL; treatment is surgical

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33
Q

Median nerve distribution

A

volar aspect of hand from thumb to radial aspect of 4th digit

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34
Q

Thickening of median nerve +/- adjacent edema

A

carpal tunnel syndrome; may present with thenar atrophy

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35
Q

Carpal tunnel syndrome associations

A

dialysis, pregnancy, diabetes, hypothyroidism

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36
Q

Guyon’s canal syndrome

A

ulnar nerve entrapment in Guyon’s canal (formed by pisiform and hamate)

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37
Q

Handle bar palsy

A

Guyon’s canal syndrome; may also be caused by hook of hamate fracture

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38
Q

Smith fracture

A

opposite of Colles; distal radial metaphyseal fracture with volar angulation; both are often assoc. with ulnar styloid fracture

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39
Q

Barton fracture

A

intra-articular fracture of distal radius (radial rim); dorsal or volar dislocation of radio-carpal joint (volar more common)

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40
Q

Normal volar tilt of distal radius

A

11 degrees; must have true lateral view to measure

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41
Q

Positive ulnar variance association

A

ulnar impaction syndrome => TFCC destruction + lunate degeneration (possibly cystic)

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42
Q

Tendon associated with TFCC

A

ECU (compartment 6)

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43
Q

Capitellum fracture association

A

posterior elbow dislocation

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44
Q

Essex-Lopresti

A

radial head fracture + dislocation of DRUJ; considered unstable (rupture of interosseous membrane)

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45
Q

Causes of cubital tunnel syndrome

A

accessory anconeus, overuse, humeral fracture, mass lesion; results in thickening of ulnar nerve

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46
Q

Best view to see Hill-Sachs (x-ray)

A

internal rotation

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47
Q

Signs of posterior shoulder dislocation

A

> 6 mm between glenoid and humerus, reverse Hill-Sachs (trough sign), locked in internal rotation

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48
Q

Inferior shoulder dislocation associations

A

rotator cuff tear, greater tuberosity injury; 60% get nerve injury (axillary nerve most commonly)

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49
Q

Most common location for fibrous dysplasia

A

ribs

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50
Q

Post-op shoulder: glenoid intact + cuff intact

A

hemi-arthroplasty or resurfacing

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51
Q

Post-op shoulder: glenoid intact + cuff deficient

A

hemi-arthroplasty or reverse arthroplasty

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52
Q

Post-op shoulder: glenoid deficient + cuff intact

A

total shoulder arthroplasty

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53
Q

Post-op shoulder: glenoid deficient + cuff deficient

A

reverse arthroplasty

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54
Q

Most common complication of total shoulder arthroplasty

A

loosening of glenoid component

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55
Q

“Anterior escape”

A

complication of total shoulder arthroplasty; anterior migration of humeral head after subscapularis failure

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56
Q

Complication of reverse should arthroplasty

A

posterior acromion fracture (from deltoid tugging)

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57
Q

Classic stress fracture locations

A

medial femoral diaphysis, medial femoral neck, posterior-lateral tibial shaft

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58
Q

Trauma patient with foot/leg locked in internal rotation

A

posterior hip dislocation

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59
Q

Most common type of hip dislocation

A

posterior (dashboard injury)

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60
Q

Acetabular injury with disruption of iliopectineal line

A

anterior column fracture

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61
Q

Acetabular injury with disruption of ilioischial line

A

posterior column fracture

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62
Q

Complication of intracapsular hip fracture

A

disruption of blood supply (circumflex femoral a.) => AVN; degree of fracture displacement corresponds to risk of AVN

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63
Q

Muscle(s) implicated in iliac crest avulsion injury

A

abdominal muscles (EO/IO/TA)

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64
Q

Snapping hip syndrome algorithm

A

clinical evaluation to r/o external type => x-ray to r/o intra-articular type (degen. changes, loose bodies) => US to r/o internal type (iliopsoas snapping of iliopectineal eminence) => MR arthrogram to r/o intra-articular type (labral tears)

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65
Q

Most common type of snapping hip syndrome

A

external/lateral (IT band snapping over greater trochanter)

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66
Q

Most common location for labral tears (hip)

A

anterior-superior

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67
Q

FAI demographics

A

cam-type = males, average age is 32 y/o; pincer-type = females, average age is 40 y/o; results in early degen. changes

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68
Q

Measurement suggestive of cam-type FAI

A

alpha angle >55 degrees

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69
Q

Crossover sign (acetabulum)

A

pincer-type FAI

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70
Q

Coxa profunda vs. protrusio acetabuli

A

coxa profunda = acetabulum projects medial to ilioischial line; protrusio acetabuli = acetabulum and femoral head project medial to ilioischial line; there may be an association with either type and pincer-type FAI

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71
Q

Causes of sacral insufficiency fracture

A

osteoporosis, renal failure, RA, pelvic radiation, extended steroid use, mechanical changes after hip arthroplasty

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72
Q

Reverse segond fracture associations

A

PCL and medial meniscus injury; occurs due to external rotation (opposite of a segond fracture)

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73
Q

Arcuate sign association

A

PCL injury

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74
Q

Patellar tendon tear associations

A

SLE, RA, elderly, trauma/sports

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75
Q

Bilateral patellar tendon tears

A

chronic steroid use

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76
Q

Most common type of tibial plateau fracture

A

Schatzker type 2 (split and depressed lateral tibial plateau fracture); in general, lateral > medial

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77
Q

Salter-Harris type for a juvenile Tillaux fracture

A

type 3; medial physis fuses before lateral physis

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78
Q

Salter-Harris type for a triplane fracture

A

type 4

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79
Q

Maisonneuve fracture

A

medial malleolar fracture or disruption of distal tibiofibular syndesmosis, + a proximal fibular fracture; unstable

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80
Q

Bilateral calcaneal fractures - NEXT STEP

A

image spine (r/o compression or burst fractures)

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81
Q

Bohler’s angle concerning for calcaneal fracture

A

<20 degrees

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82
Q

Jones fracture

A

fracture at base of the 5th metatarsal

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83
Q

Causes of 5th metatarsal avulsion fracture

A

tug from peroneus brevis or plantar aponeurosis (lateral cord)

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84
Q

Mechanism of Lisfranc injury

A

extreme plantar flexion + axial load; cannot exclude on non-weightbearing films; high risk for non-union and post-traumatic arthritis

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85
Q

Fleck sign

A

small bony fragment in Lisfranc space associated with avulsion of the Lisfranc ligament

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86
Q

Tensile stress fracture locations in femur and tibia

A

lateral femoral neck and anterior tibia, respectively

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87
Q

SONK

A

insufficiency fracture, most commonly of medial femoral condyle; “old lady with no history of trauma”

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88
Q

SONK association

A

meniscal injury

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89
Q

March fracture

A

metatarsal stress fracture; e.g. military recruits

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90
Q

Most fractured tarsal bone

A

calcaneus (75% intra-articular)

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91
Q

High risk stress fractures

A

lateral femoral neck, transverse patella, anterior tibia, 5th metatarsal, talus, tarsal navicular, great toe sesamoid

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92
Q

Looser zones

A

insuffiency fractures (pseudofractures) seen in osteomalacia, rickets, osteogenesis imperfecta; femoral neck and pubic rami (classically)

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93
Q

Looser zone findings

A

lucency with surrounding sclerosis; occur at right angles to cortex; often symmetric

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94
Q

Most common complication of osteoporosis

A

insufficiency fracture (spine > hip > wrist)

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95
Q

False positive DEXA

A

laminectomy

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96
Q

False negative DEXA

A

osteophytes, dermal calcifications, metal, compression fracture, too much femoral shaft included (hip)

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97
Q

Sudeck atrophy

A

a.k.a. RSD or CRPS

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98
Q

Unilateral severe osteopenia with preserved joint spaces

A

reflex sympathetic dystrophy; hand and shoulder most commonly

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99
Q

Transient osteoporosis of hip findings

A

osteopenia on x-ray, edema on MRI, hot on bone scan; 3rd trimester female with hip pain classically; self-limited

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100
Q

Regional migratory osteoporosis

A

migratory osteopenia and joint pain; more common in men; self-limited

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101
Q

Osteochondral lesion with surrounding high T2 signal

A

stage 3, unstable; may lead to secondary OA if untreated

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102
Q

Panner vs. Kohler vs. Sever vs. Kienbock

A

Panner = capitellum; Kohler = navicular; Sever = calcaneus; Kienbock = lunate; osteonecrosis, may cause growth disturbance

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103
Q

Contents + disease for wrist compartments 1, 3, and 6

A

1 = APL, EPB (de Quervain’s); 3 = EPL (medial to Lister’s tubercle); 6 = ECU (tenosynovitis in early RA)

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104
Q

Intersection syndrome compartments

A

proximal is compartments 1 & 2; distal is compartments 2 & 3; classically in rowers

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105
Q

Contents of carpal tunnel

A

4 flexor digitorum profundus tendons, 4 flexor digitorum superficialis tendons, FPL (lateral), median nerve (lateral)

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106
Q

Structures that do not go through carpal tunnel

A

FCR, FCU, FPB, palmaris longus (if present)

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107
Q

Communication between ankle joint space and common peroneal tendon sheath

A

implies tear of calcaneofibular ligament

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108
Q

Tenosynovitis of multiple flexor tendons of the hand/wrist

A

RA (may also present as ECU tenosynovitis)

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109
Q

Superficial nodularity along the palmar aponeurosis (distal palm)

A

Dupuytren’s contracture; 50% bilateral

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110
Q

T1 dark + T2 bright mass of distal finger

A

glomus tumor (painful, at nailbed, enhancing) or epidermal inclusion cyst (painless, h/o trauma)

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111
Q

T1 dark + T2 dark mass of finger/hand

A

GCT of tendon sheath (blooming, may erode bone) or fibroma (no blooming); both enhance

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112
Q

T1 dark + T2 bright lesion along dorsal wrist

A

ganglion cyst (dorsal&raquo_space; volar)

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113
Q

Hildreth sign

A

pain associated with a glomus tumor disappears with a tourniquet

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114
Q

Osborne band

A

a.k.a. cubital tunnel retinaculum or epicondylo-olecranon ligament

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115
Q

T sign (elbow)

A

partial UCL tear; represents gad medial to sublime tubercle (MR arthrogram); seen in throwers (valgus overload)

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116
Q

Most important bundle of UCL (elbow)

A

anterior bundle

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117
Q

Low T1 + high T2 signal in the capitellum

A

Panner disease or OCD; OCD generally occurs in adolesence and may have loose bodies

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118
Q

Most common type of epicondylitis

A

lateral epicondylitis (tennis elbow)

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119
Q

Structures involved in lateral epicondylitis

A

ECRB +/- LCL complex; NOT an avulsion injury

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120
Q

Structures involved in medial epicondylitis

A

common flexor tendon (CFT); may see ulnar nerve thickening; NOT an avulsion injury

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121
Q

Dialysis elbow

A

olecranon bursitis related to constant pressure from arm positioning

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122
Q

Epitrochlear lymphadenopathy

A

consider cat scratch disease

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123
Q

Causes of external impingement resulting in supraspinatus injury

A

a.k.a. subacromial impingement; hook acromion (type 3), subacromial osteophytes, os acromiale, thickened coraco-acromial ligament

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124
Q

Causes of external impingement resulting in subscapularis injury

A

a.k.a. subcoracoid impingement; between lesser tuberosity and coracoid; less common

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125
Q

Causes of internal impingement (shoulder)

A

multi-directional glenohumeral instability, posterior-superior type, anterior-superior type

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126
Q

Posterior-superior type of internal impingement (shoulder)

A

infraspinatus and posterior supraspinatus tendons pinched between greater tuberosity and labrum; throwers, swimmers, tennis players

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127
Q

Anterior-superior type of internal impingement (shoulder)

A

subscapularis and biceps tendons pinched against anterior-superior labrum

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128
Q

Abnormal signal in rotator interval

A

adhesive capsulitis; may see loss of fat and/or enhancement in rotator interval

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129
Q

Thickening of axillary pouch (shoulder)

A

adhesive capsulitis; >4 mm thickening; also with decreased glenohumeral joint volume

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130
Q

Partial tear thickness requiring surgical intervention (shoulder)

A

> 50%; articular surface tears are more common than bursal surface tears

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131
Q

Least common rotator cuff muscle to tear

A

teres minor

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132
Q

SLAP tear type with extension into biceps tendon

A

type 4; treatment requires debridement + biceps tenodesis

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133
Q

Most common type of SLAP tear

A

type 2; SLAP tears are typically related to over head movements and are NOT considered unstable

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134
Q

Sublabral foramen

A

unattached labrum from 1 to 3 o’clock

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135
Q

Absent anterior-superior labrum + thickened MGHL

A

Buford complex

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136
Q

Anterior-inferior labral injury with adjacent articular cartilage injury (shoulder)

A

GLAD lesion; stable

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137
Q

GLAD (acronym)

A

glenoid labral articular disruption; anterior-inferior superficial labral tear with associated cartilage injury

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138
Q

Anterior-inferior labral injury with minimal displacement of intact periosteum (shoulder)

A

Perthes lesion; unstable

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139
Q

Anterior-inferior labral injury with medial displacement of intact periosteum (shoulder)

A

ALPSA lesion; unstable

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140
Q

ALPSA (acronym)

A

anterior labro-ligamentous periosteal sleeve avulsion

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141
Q

Anterior-inferior labral injury with disruption of periosteum (shoulder)

A

Bankart lesion; unstable

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142
Q

Posterior glenohumeral instability lesions

A

reverse Bankart, POLPSA, Bennett lesion, Kim lesion

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143
Q

POLPSA (acronym)

A

posterior labro-capsular periosteal sleeve avulsion; results in a recess that communicates with joint space

144
Q

Bennett lesion (shoulder)

A

a.k.a. thrower’s exostosis; avulsion of posterior band of IGHL => posterior extra-articular ossification; assoc. with posterior labral injury

145
Q

Kim lesion (shoulder)

A

incompletely avulsed or flattened posterior labrum; labral-cartilage relationship is preserved

146
Q

HAGL (acronym)

A

humeral avulsion of the inferior glenohumeral ligament; occurs at humeral attachment of IGHL; unstable

147
Q

HAGL associations

A

often due to anterior shoulder dislocation; assoc. with subscapularis tendon tears

148
Q

Biceps tendon subluxation vs. dislocation

A

subluxation is seen with transverse ligament injury; dislocation is seen with transverse ligament + biceps pulley injury

149
Q

Biceps tendon dislocation association

A

subscapularis tendon tears

150
Q

Avulsion-type partial undersurface tear (shoulder)

A

PASTA lesion (or “rim rent tear”)

151
Q

Partial undersurface tear extending into tendon (shoulder)

A

PAINT lesion

152
Q

Result of lesion at spinoglenoid notch

A

distal suprascapular nerve impingement => isolated infraspinatus atrophy

153
Q

Result of lesion at suprascapular notch

A

proximal suprascapular nerve impingement => infraspinatus + supraspinatus atrophy

154
Q

Result of lesion in the quadrilateral space

A

axillary nerve impingement => teres minor +/- deltoid atrophy

155
Q

Borders of quadrilateral space

A

humerus (lateral), teres minor (superior), long head triceps (medial), teres major (inferior)

156
Q

Parsonage-Turner

A

idiopathic brachial plexus neuropathy; consider when multiple nerve distributions involved (e.g. axillary and suprascapular)

157
Q

Function of ACL bundles

A

anteromedial bundle tightens knee in flexion; posterolateral bundle tightens knee in extension

158
Q

Conjoint tendon (knee)

A

formed by LCL and biceps femoris

159
Q

Meniscocapsular separation

A

separation of medial meniscus and MCL

160
Q

Discoid meniscus - medial or lateral most commonly?

A

lateral; prone to tears; Wrisberg variant is rare and super prone to tears

161
Q

Bucket handle tear - medial or lateral most commonly?

A

medial; shown as absent bowtie, double PCL, or double delta signs; double PCL = medial meniscus tear

162
Q

Significance of double PCL sign

A

can only occur with intact ACL

163
Q

Meniscal ossicle association

A

radial tear of root of medial mesiscus; ossicle = ossification within posterior horn of medial meniscus

164
Q

O’Donoghue’s unhappy triad

A

ACL tear, MCL injury, medial meniscus tear

165
Q

Contusion pattern associated with ACL tear

A

lateral femoral condyle + posterior lateral tibial plateau

166
Q

Blumensaat angle >15 degrees

A

probable ACL tear (normal is <15 degrees); apex of angle pointing inferiorly is also a sign of ACL tear

167
Q

Celery stalk appearance of ACL

A

mucoid degeneration; predisposes to ACL ganglion cysts

168
Q

Fibular head edema

A

suggest posterolateral corner injury

169
Q

Contents of posterolateral corner

A

IT band, biceps femorus, LCL, popliteus tendon; missed PLC injury is a source of ACL reconstruction failure

170
Q

Tibial tunnel placed anterior to Blumensaat’s line (ACL repair)

A

risk of roof impingement; positioning of tibial tunnel is primary factor in preventing impingement

171
Q

Primary factor for maintaining isometry (ACL repair)

A

positioning of femoral tunnel; isometry = constant length and tension

172
Q

Best view for evaluation of anterior-inferior labrum (MRI)

A

ABER view; ABER = ABduction External Rotation

173
Q

PCL tear - NEXT STEP

A

check for popliteal flow void (may need CTA run-off)

174
Q

Patellar dislocation associations

A

MPFL tear; may be assoc. with trochlear dysplasia (too flat)

175
Q

Increased risk of tear with meniscal flounce?

A

NOT assoc. with an increased incidence of meniscal tears

176
Q

Fabella location

A

sesamoid located within lateral head of gastrocnemius; seen posterior to lateral femoral condyle

177
Q

Cyamella location

A

sesamoid located within popliteus tendon; seen lateral to popliteal groove (femur)

178
Q

Most common accessory muscle of ankle

A

peroneus quartus (lateral ankle); accessory soleus and accessory FDL are both in medial ankle

179
Q

Insertions of biceps and brachialis tendons

A

radial tuberosity and coronoid process (ulna), respectively

180
Q

Most frequently injured ankle ligament

A

ATFL

181
Q

Posterior tibial tendon injury progression

A

PTT injury => spring ligament injury => flat foot => sinus tarsi syndrome => plantar fasciitis

182
Q

Primary stablizer of the longitudinal arch (foot)

A

posterior tibialis tendon; acute tears occur near insertion on navicular, chronic tears occur posterior to medial malleolus

183
Q

Acute flat foot

A

consider PTT tear; may also have hindfoot valgus

184
Q

Split peroneus brevis association

A

lateral ankle ligament injury; seen with inversion injuries

185
Q

Anterolateral impingement syndrome (ankle)

A

injury to ATFL/tibiofibular ligaments => lateral instability => chronic synovitis => scarred mass in lateral gutter (low T1/T2)

186
Q

Sinus tarsi syndrome associations

A

PTT injury, rheumatologic disorders

187
Q

Pain and paresthesias in toes or sole of foot

A

tarsal tunnel syndrome (compression of tibial nerve); causes are idiopathic, ganglion cyst, NF1, post-calcaneal fracture

188
Q

Loss of plantar flexion

A

consider Achilles tendon injury; may still be able to plantar flex ankle if a plantaris muscle is present

189
Q

Fusiform thickening of Achilles tendon

A

Achilles xanthoma (often bilateral); assoc. with familial hypercholesterolemia

190
Q

Plantar fascia thickness suggestive of plantar fasciitis

A

> 4 mm (with adjacent T2 signal); symptoms worsened with dorsiflexion of toes; most commonly involves central band

191
Q

7-10 days

A

time frame when early osteomyelitis may be occult; also time to repeat x-ray if suspicion for occult fracture

192
Q

Sequestrum

A

necrotic bone surround by granulation tissue; seen in chronic osteomyelitis

193
Q

Involucrum vs. cloaca

A

involucrum = living bone surrounding necrotic bone; cloaca = opening in involucrum; seen in chronic osteomyelitis

194
Q

Sequestrum DDx

A

chronic osteomyelitis, osteoid osteoma (mimic), EG, lymphoma, fibrosarcoma

195
Q

Age when infection can spread from metaphysis to epiphysis via blood

A

<18 months

196
Q

Initial site of infection in discitis-osteomyelitis - peds vs. adults

A

peds = intervertebral disc with spread to adjacent bone; adults = subchondral bone with subsequent spread to disc

197
Q

Characteristics of spinal TB

A

spares disc space, Gibbus deformity, psoas abscess, large paraspinal abscess, skip lesions

198
Q

Septic arthritis of sternoclavicular joint

A

IV drug users

199
Q

Synovial enhancement + joint effusion

A

non-specific, but suspect septic arthritis (especially if abnormal periarticular marrow signal)

200
Q

Fournier gangrene

A

necrotizing fasciitis of the scrotum; nec fasc is most often polymicrobial

201
Q

Spina ventosa

A

tuberculous dactylitis; seen in kids, expansile lesion with adjacent soft tissue swelling, no periosteal reaction

202
Q

Lesion characteristics associated with increased risk of pathologic fracture

A

lytic lesion, >3 cm in size, involve >50% of cortex; based on x-ray or CT

203
Q

Osteosarcoma subtype with best prognosis

A

parosteal (followed by periosteal); secondary osteosarcoma has worst prognosis

204
Q

Fluid-fluid level DDx

A

telangiectatic osteosarcoma, GCT, ABC; synovial sarcoma or lymphatic malformation if soft tissue mass

205
Q

Causes of secondary chrondrosarcoma

A

Paget disease, osteochondroma, Maffucci > Ollier

206
Q

52 y/o with chondroblastoma

A

clear cell chondrosarcoma; chondroblastoma is a pediatric lesion

207
Q

Lytic lesion of bony pelvis DDx (peds)

A

Ewing’s, osteosarcoma, LCH, neuroblastoma met, lymphoma/leukemia, osteomyelitis

208
Q

Lytic lesion of bony pelvis DDx (adult)

A

chondrosarcoma, mets, myeloma, MFH, lymphoma/leukemia, brown tumor, osteomyelitis; chordoma if midline sacrum

209
Q

Aggressive bony neoplasm with skip lesions

A

Ewing’s

210
Q

Most common location for chordoma

A

sacrum > clivus > C-spine (C2 most commonly)

211
Q

T2 dark or iso soft tissue mass

A

MFH/PUS (50% T2 dark/iso); may also have an osseous origin (NO periosteal reaction)

212
Q

Pleomorphic undifferentiated sarcoma

A

a.k.a. MFH; old people; proximal arms/legs, retroperitoneum; radiation and Paget’s are risk factors; may arise from bone infarct

213
Q

Soft tissue mass with spontaneous hemorrhage

A

MFH; MFH is more common than synovial sarcoma

214
Q

Soft tissue mass near a joint in 30 y/o

A

synovial sarcoma; 20-40 y/o; “triple sign” or multiple fluid-fluid levels

215
Q

Soft tissue mass with calcifications and adjacent bony erosion in 30 y/o

A

synovial sarcoma; prefers distal lower extremities (foot, ankle, lower leg)

216
Q

Soft tissue mass with high T2 signal and phleboliths

A

venous malformation (a.k.a. soft tissue hemangioma); T2 dark phleboliths, enhancing, may contain fat; NO flow voids

217
Q

Soft tissue mass with numerous flow voids

A

arteriovenous malformation (AVM)

218
Q

Intramuscular mass with high T2 signal +/- low signal septations

A

intramuscular myxoma; mild enhancement, +/- low signal septations, +/- flame-shaped adjacent high T2 signal

219
Q

Fluid-filled soft tissue lesion with thin enhancing septations

A

lymphatic malformation

220
Q

Infantile hemangioma

A

usually not present at birth, natural history is growth then involution in childhood; T2 bright, enhancing, may have flow voids; assoc. with PHACES; do NOT contain phleboliths; this is different than a congenital hemangioma (which is fullly developed at birth)

221
Q

Most common liposarcoma in <20 y/o

A

myxoid; T2 bright, T1 dark, enhancing components

222
Q

Distal femoral metaphyseal defect/irregularity

A

a.k.a. cortical desmoid

223
Q

Most common carpal coalition

A

lunotriquetral

224
Q

Madelung deformity associations

A

prior trauma, Turner syndrome, Hurler’s, achondroplasia, multiple hereditary exostoses

225
Q

Iliac horns

A

seen in nail-patella syndrome or Fong syndrome (“Fong’s prongs”)

226
Q

Fused cervical vertebral bodies

A

Klippel-Feil syndrome, JIA; vertebral bodies may be small in either; may see isolated fusion of posterior elements in JIA

227
Q

Osteogenesis imperfecta type most associated with multiple fractures

A

type 3; type 1 is most common; type 2 is lethal

228
Q

Intramuscular myxoma association

A

Mazabraud syndrome (polyostotic FD + multiple myxomas); risk of malignant transformation (of FD)

229
Q

Osteosarcoma vs. Ewing’s treatment

A

both get chemo then wide excision, but Ewing’s also gets radiation (chemoradiation)

230
Q

Chondrosarcoma treatment

A

wide excision only

231
Q

Do Not Touch lesions

A

cortical desmoid, Pitt’s pit (synovial herniation pit), myositis ossificans

232
Q

Bone biopsy considerations

A

avoid gluteal muscles, avoid communicating bursae, avoid quadriceps tendon, avoid posterior 2/3 of shoulder (axillary nerve)

233
Q

Epiphyseal equivalents

A

calcaneus, carpals, patella, trochanters, most apophyses

234
Q

“Long lesion a long bone”

A

fibrous dysplasia; no periosteal reaction; polyostotic <10 y/o, monostotic 20-30 y/o (young people)

235
Q

Anterior tibial lesion with anterior tibial bowing

A

osteofibrous dysplasia; benign, tibia or fibula; cannot reliably be differentiated from adamantinoma

236
Q

Treatment for adamantinoma

A

en bloc resection (locally aggressive with risk of metastases); NOT benign

237
Q

“Floating tooth”

A

EG classically, but broad differential including osteomyelitis and mandibular lesions

238
Q

GCT characteristics

A

closed physis, abuts articular surface, eccentric, sharply marginated border; usually non-sclerotic rim (not always); risk of malignant transformation

239
Q

GCT treatment

A

wide excision + arthroplasrty; malignant transformation in 5% (often with lung mets)

240
Q

Secondary ABCs may arise from…

A

GCT (most common), osteoblastoma, chondroblastoma + other osseous lesions less commonly

241
Q

Fibrous cortical defect vs. NOF

A

FCD <3 cm, NOF >3 cm; both are fibroxanthomas

242
Q

Jaffe-Campanacci syndrome

A

multiple NOFs, cafe au lait spots, mental retardation, cardiac malformations, hypogonadism

243
Q

Painful scoliosis (night pain)

A

osteoid osteoma; apex points away from lesion; lots of adjacent edema; most common location is long bones

244
Q

Lucent lesion in posterior elements DDx

A

osteoblastoma, ABC, TB

245
Q

Epiphyseal lesion with intermediate T2 signal + thin sclerotic rim

A

chondroblastoma; NOT T2 bright (vs. other chondral lesions), thin sclerotic rim, adjacent marrow/soft tissue edema, +/- periostitis

246
Q

Intertrochanteric lesion DDx

A

LSMFT, SBC, lipoma, fibrous dysplasia

247
Q

Multiple osseous lytic lesions DDx

A

fibrous dysplasia, EG, enchondromas, mets, myeloma, hyperparathyroidism (brown tumors)

248
Q

Lytic osseous lesion without associated periostitis DDx

A

fibrous dysplasia, enchondroma, NOF, SBC (unless fractured), ABC

249
Q

Heterotopic ossification

A

a.k.a. myositis ossificans; begins as soft tissue mass => peripheral cortical bone at 6 months (ossification, NOT calcification)

250
Q

Lipohemarthrosis - NEXT STEP

A

suggestive of an intra-articular fracture; need additional imaging

251
Q

Bilateral distal clavicular osteolysis DDx

A

hyperparathyroidism, RA, scleroderma; may also be post-traumatic (e.g. weightlifting)

252
Q

Accetabular fracture type involving iliac wing

A

both column type

253
Q

Haglund syndrome

A

Haglund deformity + insertional tendinopathy + pre-Achilles bursitis; focal pain at posterior calcaneal tuberosity; “pump bump”

254
Q

Arthrofibrosis (knee)

A

scarring in Hoffa’s fat pad following ACL reconstruction; focal form = cyclops lesion

255
Q

RCC and thyroid mets are classically lytic or blastic?

A

lytic

256
Q

Most sensitive study for myeloma

A

MRI; skeletal survery > bone scan (often negative); vertebral body destruction with sparing of posterior elements (classically)

257
Q

“Mini-brain” appearance within a vertebral body

A

plasmacytoma

258
Q

Myeloma with sclerotic mets

A

POEMS syndrome

259
Q

Shortened 4th and 5th metacarpals DDx

A

pseudohypoparathyroidism, pseudopseudohypoparathyroidism, Turner’s syndrome

260
Q

High PTH, low calcium, high phosphate

A

pseudohypoparathyroidism; PTH increases serum calcium and decreases serum phosphate

261
Q

Features of osteochondroma concerning for malignant transformation

A

cap thickness >1.5 cm, assoc. soft tissue mass, pain; increased risk with MHE

262
Q

Pain associated with an enchondroma or osteochondroma

A

suspicious for malignant transformation

263
Q

Dysplasia epiphysealis hemimelica

A

a.k.a. Trevor disease; osteochondromas within epiphyses; ankle > knee

264
Q

Compression of which nerve is associated with an avian spur?

A

median nerve (compressed by ligament of Struthers); avian spur points towards joint

265
Q

Juxta-cortical chondroma

A

benign lesion, 10-40 y/o; causes saucerization of external cortex with periosteal reaction; fingers, proximal humerus, distal femur

266
Q

Timing of physiologic bowing

A

18-24 months; smooth, lateral, bilateral; self-limited

267
Q

Anterolateral tibial bowing

A

NF1; often with tibial or fibular pseudarthroses

268
Q

Forestier disease

A

a.k.a. DISH; 4 or more contigous levels of involvement, spares disc space, thoracic spine most commonly; assoc. with OPLL

269
Q

Synovial chondromatosis findings (MRI)

A

high T2, low T1 intra-articular nodules; often with adjacent bony erosion; malignant transformation is rare

270
Q

Lateral tibial bowing with widening and irregularity of growth plates

A

rickets, or hypophosphatasia (if neonate)

271
Q

Classic location for OA vs. RA in the foot

A

OA is 1st MTP; RA is 5th metatarsal head (MTP)

272
Q

Patterns of femoral head migration - OA vs. RA

A

OA is superolateral or medial migration; RA is axial migration

273
Q

“Surgical-like margins”

A

neuropathic joint; e.g. due to syringomyelia, spinal cord injury

274
Q

5 D’s of neuropathic joints

A

deformity, debris, dislocation, dense subchondral bone, destruction of articular cortex

275
Q

Felty syndrome

A

RA + splenomegaly + neutropenia

276
Q

Caplan syndrome

A

RA + pneumoconiosis; supposedly upper lobe predominant, whereas rheumatoid lung is typically lower lobe predominant

277
Q

Fluffy periostitis + erosions

A

psoriatic arthritis, reactive arthritis; reactive classically stays below waist

278
Q

Psoriatic arthritis distribution

A

IPs > MCPs; buzzwords = sausage digit, pencil-in-cup, mouse ears

279
Q

Ivory phalanx

A

psoriatic arthritis; great toe most commonly

280
Q

Ankylosis in finger DDx

A

psoriatic arthritis or erosive OA

281
Q

First site of involvement in ankylosing spondylitis

A

typically SI joints; if you’re thinking AS in the spine, but hip joints are shown and normal => it’s not AS

282
Q

Minor trauma in patient with DISH or AS - NEXT STEP

A

whole spine CT

283
Q

Complications of hip replacement in an AS patient

A

significant heterotopic ossification; often receive post-op prophylactic low-dose radiation + NSAIDs

284
Q

Arthritides that spare joint space

A

gout, amyloid, SLE/Jaccoud’s

285
Q

Findings of gout (MRI)

A

juxta-articular sharply-marginated erosions with associated low T2 soft tissue mass; tophi typically enhance

286
Q

Gout mimickers DDx

A

amyloidosis, cystic RA, multicentric reticulohistiocystosis, sarcoidosis, hyperlipidemia

287
Q

Isolated patellofemoral, radiocarpal, or talonavicular disease (arthritis)

A

CPPD; hook-like osteophytes of 2nd/3rd metacarpal heads; most commonly involves knee

288
Q

Large subchondral cyst formation

A

consider CPPD (over OA)

289
Q

Uniform MCP joint space loss + hooked osteophytes

A

hemochromatosis; may also cause chondrocalcinosis

290
Q

Tuft resorption (fingers) with rib notching

A

hyperparathyroidism; also subperiosteal bone resorption along radial aspect of 2nd/3rd fingers

291
Q

Cause of Milwaukee shoulder

A

HADD; shoulder destruction with intra-articular loose bodies; history of trauma to affected joint

292
Q

Focal lateral paravertebral ossification

A

psoriatic arthritis

293
Q

Erosion of dens DDx

A

CPPD, RA, JIA

294
Q

Ulnar subluxation at MCPs

A

think RA or SLE/Jaccoud arthropathy

295
Q

Ossification of posterior longitudinal ligament (OPLL) associations

A

DISH, ankylosing spondylitis, ossification of ligamentum flavum; may cause canal stenosis and predispose to cord injury with minor trauma

296
Q

Age requirement for JIA

A

<16 y/o; carpal erosions, premature fusion of growth plates

297
Q

Amyloid arthropathy association

A

chronic dialysis; gout mimic; joint space preserved (until late); may see carpal tunnel syndrome

298
Q

Lymphatic malformation

A

a.k.a. lymphangioma or cystic hygroma; infants usually; head and neck most commonly; multi-loculated mass following fluid signal with thin enhancing septa; fluid-fluid levels are suggestive; may appear iso-to-high T1 if protein or blood

299
Q

Innominate bone

A

bone formed by fusion of ilium, ischium, and pubis

300
Q

Soft tissue calcifications DDx

A

scleroderma, poly- or dermatomyositis, SLE, HADD, myositis ossificans, secondary hyperparathyroidism; chronic renal disease may worsen HADD

301
Q

Most common indication for hip arthroplasty revision

A

loosening; >2 mm at prosthetic-bone interface is suggestive; component migration is diagnostic

302
Q

Hip arthroplasty with adjacent smooth endosteal scalloping

A

particle disease; inflammatory reaction to particles shed from arthroplasty surface; most common in non-cemented arthroplasties; may be seen around screw holes

303
Q

Eccentric position of femoral head component within acetabular component (hip arthroplasty)

A

polyethylene wear (occurs in superior-lateral direction; like OA); “creep” is a normal phenomenon that occurs in the axial direction

304
Q

Stress shielding (hip arthroplasty)

A

bone resorption in non-weight bearing areas; classically along medial or lateral aspect of proximal femur; medial = calcar resorption; assoc. with non-cemented arthroplasties; increases risk of peri-prosthetic fracture

305
Q

Red marrow in humeral and femoral heads in an adult

A

normal variant

306
Q

Order of red marrow reconversion

A

proximal metaphysis => distal metaphysis => diaphysis => epiphyses; spine and flat bones precede long bones

307
Q

Marrow darker than adjacent discs and/or muscle on T1

A

leukemia; vs. red marrow which is iso to discs/muscle on T1

308
Q

Granulocytic sarcoma

A

a.k.a. chloroma; destructive mass in bone; occurs in leukemia

309
Q

Secondary causes of calcific tendinitis (HADD)

A

chronic renal failure, hypervitaminosis D, collagen vascular disease, tumoral calcinosis

310
Q

Calcification of longus colli

A

due to HADD; neck pain with restricted ROM; may see prevertebral edema on MRI

311
Q

Fusiform enlargement and sclerosis of long bones

A

Engelmann disease; symmetric, bilateral; often in tibia, may involve skull; hot on bone scan

312
Q

MRI findings of PVNS

A

blooming, joint effusion, +/- erosions; treatment is synovectomy

313
Q

Synovial chondromatosis

A

typically mono-articular, most commonly affects knee; loose bodies may eventually ossify; treatment is removal +/- synovectomy

314
Q

Widening of hip joint space (adult)

A

pituitary gigantism; cartilage will eventually outgrow its blood supply => early OA

315
Q

Lipoma arborescens associations

A

OA, chronic RA, prior trauma; typically unilateral

316
Q

Frond-like suprapatellar mass with knee joint effusion

A

lipoma arborescens

317
Q

Causes of hip AVN

A

Perthes, sickle cell disease, Gaucher’s, steroids, intracapsular femur fracture

318
Q

Rim sign (hip MRI)

A

AVN; high T2 signal line between two low signal lines; implies instability (stage 3)

319
Q

Crescent sign (hip x-ray)

A

thin subchondral lucency in femoral head; indicates imminent collapse (stage 3)

320
Q

Stages of osteonecrosis (hip)

A

1 = radiographically occult, edema on MRI; 2 = mixed lytic/sclerotic; 3 = articular collapse; 4 = secondary OA

321
Q

“Rodent facies”

A

thalassemia; other buzzwords include “hair-on-end” skull and “jail bar” ribs; assoc. with extramedullary hematopoiesis

322
Q

Demographics of Paget’s disease

A

4% at 40 y/o, 8% at 80 y/o; M > F; polyostotic > monostotic

323
Q

Progression of Paget’s disease (phases)

A

lytic => mixed (elevated AlkP) => sclerotic (elevated hydroxyproline); prone to fractures in mixed and sclerotic phases

324
Q

Banana fracture

A

insufficiency fracture of a bowed long bone; seen in Paget’s; femur or tibia

325
Q

Saber shin

A

bowing of tibia; seen in Paget’s

326
Q

Most common complication of Paget disease

A

deafness; other complications are spinal stenosis, CN palsies, fractures, CHF, secondary hyperparathyroidism, and osteosarcoma

327
Q

Most common bone affected in Paget disease

A

pelvis; “always” involves iliopectineal line; often fibular sparing in diffuse disease

328
Q

MRI characteristics of Paget’s (by phase)

A

lytic/early mixed (active) = iso T1 with speckles, hetero T2; late mixed = high T1/T2; sclerotic = low T1/T2

329
Q

Best sequence to differentiate active Paget’s from malignant transformation

A

T1 pre-contrast; lose speckled appearance in malignant transformation (foci of high T1 signal fatty marrow)

330
Q

Gorham disease

A

a.k.a. vanishing bone disease; osteolysis + splenic cysts; skull, shoulder, and pelvis most commonly

331
Q

Eccentric geographic metaphyseal lesion with lobular and sclerotic margins

A

chondromyxoid fibroma; rarely demonstrates chondroid matrix; may be expansile; T2 bright; typically around knee

332
Q

Paraneoplastic syndromes associated with hemangiopericytoma

A

hypoglycemia, osteomalacia (oncogenic rickets)

333
Q

Erlenmeyer flask deformity (femur)

A

Gaucher disease, thalassemia, sickle cell

334
Q

Symmetric DIP erosions with preserved bone density

A

multicentric reticulohystiocytosis; may also have soft tissue nodules

335
Q

Black urine when exposed to air

A

alkaptonuria; assoc. with ochonosis (disc space narrowing with calcification at every level)

336
Q

Salt-and-pepper skull

A

hyperparathyroidism

337
Q

Bullet-shaped vertebral body DDx

A

achondroplasia, mucopolysaccharidoses, congenital hypothyroidism

338
Q

Posterior vertebral body scalloping

A

achondroplasia, mucopolysaccharidoses

339
Q

Normal acromio-clavicular and coraco-clavicular distances

A

AC joint <5 mm, CC joint <11-13 mm; CC ligament has trapezoid (lateral) and conoid (medial) ligaments

340
Q

Post-traumatic fluid collection containing echogenic foci

A

Morel-Lavallee lesion (degloving); echogenic foci = fat globules, fluid-fluid levels = blood; classically over greater trochanter

341
Q

Anisotropy (definition)

A

tendons not perpendicular to beam on US appear hypoechoic (injured); normally tendons appear hyperechoic

342
Q

Hip position for arthrogram

A

internally rotated; aim for superior femoral head-neck junction

343
Q

Shoulder position for arthrogram

A

externally rotated (supinate hand); aim for inferior-medial humeral head (slightly inside the cortex)

344
Q

Heel pad thickness suggestive of acromegaly

A

> 2.3 cm

345
Q

Calcaneal avulsion fracture at insertion of achilles

A

specific for diabetes

346
Q

Bony findings in myelofibrosis (XR/CT/MR)

A

diffuse bony sclerosis (XR/CT); VERY low T1 and low T2 fibrosis in marrow space (MR)

347
Q

Post-radiation marrow changes

A

edema/necrosis in first 3 weeks (T2 bright) => profoundly fatty marrow (high T1/T2); often with a geographic distribution (beam shape)

348
Q

Bony lesions that irritate adjacent bone DDx

A

irritation = marrow edema (MR) and/or sclerosis (XR/CT); chondroblastoma, osteoid osteoma, EG, infection

349
Q

Absence of distal femur and proximal tibia

A

hypothyroidism

350
Q

Normal Insall-Salvati ratio

A

patella tendon length-to-patella length ratio; patella alta = >1.2; patella baja = <0.8

351
Q

Size criteria for osteoblastoma

A

> 1.5 cm

352
Q

Os trigonum

A

posterior to talus; assoc. with posterior impingement syndrome of ankle (seen in ballet dancers)

353
Q

How many consecutive slices for discoid meniscus?

A

depends on slice thickness; 12 mm required (e.g. three 4 mm slices)

354
Q

Little league elbow

A

avulsion of medial epicondyle, +/- UCL sprain/tear; often with osteochondral injury of capittelum

355
Q

Causes of bone infarcts

A

sickle cell, alcoholics, radiation, Gaucher, corticosteroid excess, trauma

356
Q

Monostotic or polyostotic - Paget’s and fibrous dysplasia

A

Paget’s is more commonly polyostotic; fibrous dysplasia is more commonly monostotic

AJT CORE (12 decks)

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