DIM Flashcards
Osteochondroma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : None
Type: BBT
Age : n/a
Symptom : tender at the soft tissue d/t growing bone in the area
Detail : Most Common BBT of the appendicular skeleton
Can be the following:
-pedunculated ( Aka coat hanger ) ( aka cauliflower like ) ( looks like the
bone is growing away from the joint )
-Sesile ( growing like a round bulb)
- HME ( hereditary multiple exostosis ) ( having multiple of enchondromas
Management : Refer to orthopedist, Biopsy , CT scan, MRI
Location : Long bones Ap
Name Sign : looks like bone growing on and can clearly see where it ends and not
Unicameral Bone Cyst
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : UBC, Simple Bone Cyst , SBC
Type : Benign bone tumor
Age : Less than 20 yo
Symptom : N/A
Detail :
Management : Refer to orthopedist, Biopsy , CT scan, MRI
Location : long bones, diaphysis/metaphysis area
: centrally located meaning it is in the middle of the long bone
Name Sign : Fall Fragment sign , fracture and some fragment went into the bone
: it looks like dark round inside the long bone in the middle
Benign bone tumor
There are 14
-Encapsulated ( see exactly where the boarders of the region is)
-Short zone of transition ( see exactly where the boarder of the region is)
-Geographic lesion ( clear where and not)
-incidental finding ( no pain / symptom )
-Management:
-Refer to orthopedist, Biopsy , CT scan, MRI
Osteochondroma
UBC
ABC
GCT
Chondroblastoma
Osteoid Osteoma
Brodie’s abscess
*Enchondroma
Hemangioma
Enostoma
Osteopoikilosis
Osteaoblastoma
Osteoma
Fibrous Dysplasia
Aneurysmal Bone Cyst
AKA :
Type :
Age : @@@
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : ABC
Type : BBT
Age : less than 20 yo
Symptom : N/A
Detail : Bone expansion more than SBC
Management : Refer to orthopedist, Biopsy , CT scan, MRI
Location : Diaphysis/metaphysis of long bones
Eccentrically meaning it is on the side of the lone bone
Name Sign : looks like lytic on the long bone but it is more on the left side than on the
center
Giant Cell Tumor
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : GCT
Type : BBT
Age : 20 - 40 yo
Symptom : N/A
Detail : 20% of the time is quasi malignant meaning not all but some can be malignant
Management : Refer to orthopedist, Biopsy , CT scan, MRI
Location : Epiphysis/Metaphysics
Name Sign : @@Soap bubble appearance ( saponaceous)@@
Chondroblastoma
Type :
Age :
Management :
Location :
Name Sign :
AKA :
Type : BBT
Age : less than 20 yo
Symptom : N/A
Detail :
Management : refer to orthopedist, biopsy, CT scan, MRI
Location : epiphysis/metaphysis
Name Sign : soap bubble appearance( saponaceous )
Osteoid Osteoma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA :
Type : BBT
Age :
Symptom : Night pain relieved by aspirin
Detail : tiny dot is the prostaglandinin/ tumor / white stuff is the reaction sclerosis
fighting off the tumor
: central nidus with severe sclerosis
Management : Refer to orthopedist, CT scan, MRI , Biopsy
Location : diaphysis
Name Sign : It looks like very blastic with a small lytic dot in the center
Brodie’s Abscess
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : Chronic Osteomyelitis
Type : BBT
Age :
Symptom : Night pain relieved by aspirin, Red , Hot , swollen, Fever
Detail : appears like Osteoid osteoma
: involcrum - new bone growth
: sequestrum - dead bone material
Management : Refer to Orthopedist,
Location : metaphysis
Name Sign : looks like something is starting to rot on the bone
Enchondroma
AKA :
Type :
Age :
Symptom :
Detail : what type of syndrome is associated?
Management :
Location :
Name Sign :
AKA :
Type : BBT
Age :
Symptom :
Detail : Most Common BBT of the hands
: Ollier’s disease - multiple enchondromas
- may present with permanent deformity
- 10 to 50% rate of malignancy
: Maffuci’s syndrome : soft tissue calcification
Management : Refer to orthopedist, biopsy, CT scan,
MRI
Location : hands
Name Sign : Stippled appearance ( lots of dots )
:
Hemangioma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : Vascular tumor
Type : BBT
Age : N/A
Symptom : N/A
Detail : Most common BBT of the spine
: excess accumulation of blood vessels
: When there is 1 or 2 hemangioma it will still be
considered as hemangioma , but if there are 3, it
will be osteoperosis
Management : Refer to orthopedist , CT scan, MRI,
biopsy
Location : Spine , MC on the axial skeleton
Name Sign : Curduroy cloth appearance looks lytic with vertical lines on the vertebra
Enostoma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : N/A
Type : BBT
Age : N/A
Symptom : N/A
Detail : N/A
Management : Refer to orthopedist, MRI, CT scan, Biopsy
Location : commonly seen in the pelvics but can be in the femur or ribs
Name Sign : Bone Island, looks like a blastic/radioopaque round circle.
Osteopoikilosis
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : N/A
Type : BBT
Age : N/A
Symptom : N/A
Detail : people might think that this is blastic metastatic but blastic mets does not usually go down the knees or elbows
Management : Refer to ortho, MRI, CT , Biopsy
Location : hands, pelvis, ribs, femur
Name Sign : Multiple bone islands
Osteoblastoma
AKA :
Type :
Age :
Symptom : @@@
Detail :
Management :
Location :
Name Sign :
AKA : N/A
Type : BBT
Age : N/A
Symptom : painful scoliosis
Detail : Most common BBT to affect the neural arch (C1)
: Loves the posterior aspect of our spine, all except the vertebral body
Management : refer ortho, MRI, ct scan, biopsy, surgical surretage
Location : everything on posterior of spine, NOT THE BODY
Name Sign :
Osteoma
AKA :
Type :
Age :
Symptom :
Detail : what view is seen best x-ray
Management :
Location :
Name Sign :
AKA :
Type : BBT
Age : N./A
Symptom : N/A
Detail : Best seen on Caldwell projection ( X-ray view)
: Most common BBT to affect the skull,
Management : Refer to ortho, MRI , ct , biopsy
Location : skull, frontal sinus area
Name Sign : looks blastic in the frontal sinus
Fibrous dysplasia
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : N/A
Type : BBT
Age : any age
Symptom :
Detail : Bone being replaced by fibrous tissue
Tibia = saber shin deformity
Femur = Sheppards crook deformity
Monostotic form = 70% of the time
Polystotic form = 30% of the time
Management :
Location : Tibia, Femur,
Name Sign : Makes bone appear lytic,
: YOU MUST see deformity in the bone
to diagnose as FD,
: Rind sign= looks like a round with outer
blastic and inner lytic
looking
: Ground glass=
: Coast of Maine = the cafe au lait ( skin
mark) border is sabog ( jagged)
Neurofibromatosis
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Location :
Name Sign :
AKA : Von Recklinghausen’s disease (NF 1)
Type : Tumor of nerves
Age : N/A
Symptom :
Detail :
Management : Refer to neurologist
Location : Spine
Name Sign : scoliosis, cervical kyphosis, posterior vertebral scalloping ( meaning instead of flat it is a bit curved ) with IVF enlargement, Cafe au liats ( coast of California)
Multiple Myeloma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs:
Location :
Name Sign :
AKA : Plasmacytoma, Hematopoietic disease, Plasma cell sacroma
Type : Malignant
Age : Over 50
Symptom : Easy brusing, deep boring pain, worse at night
Detail : Most common primary malignancy of bone
Management : oncologist, CT , biopsy, Bone scan
Labs: M spike for IgG
: Elevated globulin, decreased albumin
: Bence- jones proteinuria
: ESR/ CRP
: Bone scan: COLD
@@: Normochromic normocytic anemia, Makes IGG@@
: Decreased : WBC = increase infection
Decreased Thrombocyes = easy bruising
Decreased Osteoblastic Activity = looks lytic no
bone growth
: Continue Osteoclastic activity
Location : Skull , Ribs, Pelvis, proximal humerus, femur,
VERTEBRAL BODIES only
Name Sign : Rain Drop skull
: Cannot eat the pedicle
: looks like a lot of lytic dots around the bone
marrow area
: Punched out lesions, Multiple dark
densities
Lytic Metastasis
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : Malignant
Age : Over 40
Symptom : deep boring pain, worse at night
Detail : Metastasis = Most common malignancy on bone
: spread through [L]ymph [L]ytic
: Increase osteoblastic activity which is why bone
scan is hot, but tumor spreads faster and
stronger
Management : oncologist , CT ,
Labs: Bone scan: hot
: Increased Alkaline phosphatase
Location : Skull, Spine
Name Sign : Turns bone to look darker
: It can affect the pedicle
: Cannot diff with MM unless in skull
: Swiss cheese skull
Hodgkin’s Disease
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs: what for biopsy
Location :
Name Sign :
AKA :
Type : Malignant
Age : 20-40
Symptom : deep boring pain, worse at night
Detail : Unilateral hilarity lymphadenopathy in white
males see on P-A chest x-ray
Management : oncologist, CT, biopsy, bone scan
Labs: Biopsy = Reed Sternberg cells
Location : vertebra, chest
Name Sign : Ivory vertebra
: anterior body scalloping
Blastic Metastasis
AKA :
Type :
Age :
Symptom :
Detail : how is it spread ? what can it cause?
Management :
Labs:
Location :
Name Sign :
AKA :
Type : malignant
Age : Over 40
Symptom : deep boring pain, worse at night
Detail : Metastasis is the most common malignancy of
bone
: Spread through [B]lood [B]lastic
Management : oncologist, CT , biopsy, bone scan
Labs: Increased alkaline phosphatase
: Bone scan: hot
Location : vertebral body
Name Sign : Ivory white vertebra
: No enlargement, no scalloping, no cortical
thickening,
: Can cause pathological fractures
Paget’s Disease
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs: @@@
Location :
Name Sign :
AKA : Osteotitis deformans
Type : malignancy
Age : Over 50
Symptom : Bone pain, deep boring pain, worse at night
Detail : Stages: 1.) destructive or lytic
2.) lytic and blastic
3.) sclerotic healing - ivory vertebra
4.) malignant in this stage it becomes
osteosacroma
Management : Adjust above and below the affected
area IF NOT MALIGNANT meaning stage
1,2,3
: If not malignant , refer to rheumatologist,
endocrinologist
: if malignant, refer oncologist, Ct, Biopsy,
bone scan
Labs: Increased alkaline phosphatase
: Increased urinary hydroxyproline
: Bone scan: Hot
Location : Tibia, Femur, Skull, pelvis, vertebra
Name Sign : Saber shin deformity ( Tibia deformity)
: Sheppard’s crook deformity ( femur)
: Ivory white vertebra - enlargement-wider
: Picture frame vertebra
: Brim sign, unilateral or bilateral ( pelvis)
: Cotton wool appearance ( skull)
: Osteoporosis Circumscripta ( Large dark
lesion)
: Coarsened trabelulae- sheaves of wheat or
grain
: Basal invagination
Osteosacroma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : malignant
Age : 10-30
Symptom :
Detail : Most common malignancy in children
: stage 4 of pagets
Management : oncologist, CT, biopsy, bone scan
Labs: Increased Alkaline phosphatase
: Bone scan: hot
Location : diaphysis of long bone
Name Sign : Speculated / radiating / sunburst
appearance
: looks blastic that have spikes on the
diaphysis
Chondrosacroma & Fibrosacroma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : malignant
Age : over 40 yo
Symptom :
Detail : exact same as Osteosacoma but age is diff
Management : oncologist, CT, biopsy, bone scan
Labs: Increased alkaline phosphatase
Location : diaphysis of long bone
Name Sign : sunburst, radiating, speculated appearance
of diaphysis
Ewing’s sarcoma
AKA :
Type :
Age :
Symptom : @@@
Detail : @@@
Management :
Labs:
Location :
Name Sign : 5
AKA :
Type : malignant
Age : 10-25 yo
Symptom : red hot swollen
Detail : Increase density around lesion
Management : oncologist, bone scan, ct, biopsy
Labs:
Location : Common in diaphysis of long bone
Name Sign : multi parallel onion skin, type of periostea
reaction
: Liminated skin
: Codman triangle
: saucerization
: Bone expansion
Chordoma
AKA :
Type :
Age :
Symptom :
Detail :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : malignant
Age : Over 40 yo
Symptom :
Detail : most commonly found in sacrum , 2nd in skull
Management : oncologist, ct, biopsy, bone scan
Labs:
Location :
Name Sign :
Ivory white vertebra
Hodgkin lymphoma- anterior scalloping - 20-40
blastic met - no change on vertebra - over 40
pagets - widening of vertebra - over 50
Decreased alkaline phosphatase
zinc,
malnutrition,
pernicious anemia,
thyroid disease,
Wilson disease
hypophosphatasia,
Increased Alkaline phosphatase
Pagets
Osteosacroma
Lytic and blastic met
fibrosarcoma & chondrosacroma
Hyperparathyroidism
Calcified prostate
Reed sternberge cells
Hodgkin lymphoma
Saber shin & shepperd crook
Paget
Fibrous Dysplasia
Bone scan : cold
MM
Over 50 yo
MM
Pagets
Over 40
Metastasis
Chordoma
Chondrosacroma & Fibrosarcoma
Malignant
9
MM
Lytic mets
Blastic mets
pagets
osteosacroma
Fibrosacroma & Chondrosacroma
Chordoma
Ewing sacroma
hodgkin lymphoma
Types of scoliosis
Rotatory = spinous is going on concavity
Simple = spinous is going to convexity
Lines of mensuration for scoliosis
Cobb’s = best method
risser furgeson
Test for scoliosis
Adam test
Scoliosis measurement for 25 yo and younger
under 20 = adjust and monitor
21-40 = refer to orthopedist for bracing ( Milwaukee/
boton brace
Over 40 = surgical consultation
Over 50 = cardio pulmonary compromise & did
scoilios for over 25 yo
adjust only
after growth plates closed = no need for referral
Monitor scoliosis progression
1.) left wrist X-ray = best
2.) riser sign = 2nd best
3.) tanner staging = least
- the younger the father degree can go
Inflammatory Seropositives artritis
RA
Systemic lupus
Schleroderma
Inflammatory Seronegative artitis
psoriatic arthritis
Enteropathic arthropathy
AS
Reiter’s
Non inflammatory arthritis AKA degenerative
DJD = OA
DISH
Neurogenic arthropathy AKA Charcot joint
synoviochondrometaplacia
Metabolic artritis
Gout
CPPD
HAAD
other artritis
septic
+FANA
RA
Lupus
Rheumatoid Arthritis
AKA :
Type :
Age :
Symptom :
Management :
Labs:
Location :
Name Sign : 11
AKA : Still’s disease in children
Type : Seropositive Arthritis
Age : 20-40 female, Over 40 male
Symptom : Soren’s= When presenting with dry eyes
and mouth
Detail :
Ortho :
Management : adjust to tolerance, rheumatologist, check for instability for Atlanto-axial
Labs: +RA latex
: +FANA
: +ESR
: +CRP
: normocytic normochromic anemia ( same as MM)
Location : Hands, pelvis
Name Sign : Rat bite erosion
: symmetrical distribution
: bilateral uniform loss of joint space
: pannus formation
: localized periarticular osteoperosis
: DIP are spared
: affects the MCP ( Haygarth’s nodes)
: Swan neck and boutonniere deformity
: Ulnar deviation or fibular deviation( lanes
deformity)
: Atlanta-axial instability (C1 C2 )
: Baker’s cyst = benign swelling of the semi
membranous bursa
Ankylosing Spondylitis
AKA :
Type :
Age :
Symptom : where it starts?
Detail : associated with what
Ortho :
Management :
Labs:
Location :
Name Sign : 9
AKA : Marie Stumpell , Bilateral sacroilitis
Type : Seronegative Arthritis
Age : Male 15-35
Symptom : Low back pain with morning stiffness
: starts in the lower 1/3 of SI joint
Detail : Associated with iritis
Ortho : Chest expansion, Forester’s bowstrings, Lewin’s
supine
Management : Co- treat with rheumatologist
: Back extension exercise
: Deep breathing, swimming
: Chiropractic care of unaffected area
Labs: +HLA B27
: ESR
: CRP
Location : Spine, SI joint,
Name Sign : Ghost sign = Bilateral SI join fusion
: Star sign = blastic looking at the tip of the
SI joint
: Shiny Corner sign = hard to find
: Bilateral MARGINAL syndesmophytes =
spine
: squaring of vertebral bodies
: Bamboo spine = eggshell
: Dagger sign = interspinous supra spinous
: Trolley track sign = Capsular log, facet
: Poker spine
+HLA B27
Seronegative
Psiruativ arthritis
Enteropathic arthritis
AS
Reiter
Enteropathic Arthropathy
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : Seronegative Arthritis
Age : Same as AS
Symptom : Same as AS +
: GI dysfunction
: Chrohn’s dx = mucus
: Ulcertitive colitis = bloody
: IBS = diarrhea + constipation
Detail : most commonly found in females
Ortho :
Management : adjust to tolerance, co-manage with
rheumatologist, check for instability upper
cervical
Labs: HLA 27+
: ESR
: CRP
Location : pelvis
Name Sign :
Psoriatic Arthritis
Type :
Age :
Symptom :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : seronegative arthritis
Age : 20-50
Symptom : silver scaly lesion on extensors
: and on surface of elbow, knees and back
: pitted nails
: cocktail sausage digits = brown swollen
fingers
:
Detail :
Ortho :
Management : Adjust to tolerance, Co-manage with rheumatologist, Check for instability
Labs: +HLA B27
: ESR
: CRP
Location : DIP, spine
Name Sign : Increased joint space
: mouse ear deformity
: pencil in cup deformity
: Ray sign
: atlanto-axial instability
: non-marginal syndesmophytes in the spine
Reiter’s Disease
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA : Reactive arthritis
Type : Seronegative Arthritis
Age : 20-50
Symptom : Urethritis = can’t pee
: Conjunctivitis = can’t see
: arthritis = can’t dance
Detail : Caused by Chlamydia
Ortho :
Management :
Labs: +HLA B27, ESR, CRP
Location : spine, feet
Name Sign : Calcaneal spur = spur
: fluffy periostosis = looks like a line @
calcaneus
: non- marginal syndesmophytes
Systemic Lupus Erthematosus
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : Seropositive Arthritis
Age : 20-40
Symptom : Malar / Butterfly rash = from sunlight
: Oral ulcers
: Discoid lesions = scan in skin
: alopecia = hair less
: affect kidney
: Raynaud phenomenon = Pale, blue, red
hands
Detail : Autoimmune dx
: Immune system attacks collagen in ligament,
tendon and skin
Ortho : positive rebound effect
Management : Co manage - rheumatologist
: adjust uninvolved area
: x-ray check instability Atlanta axial
Labs: +LE prep
: +FANA
: +RA Latex
: +ESR
: CRP
: leukopenia
: Thrombocytopenia
: Anti-DNA
Location : hands
Name Sign : Ulnar deviation with no joint destruction
Scleroderma
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA : Progressive systemic sclerosis
Type : seropositive arthritis
Age : 30-40
Symptom :
Detail : Erosion of the distal tuffs of phalanges
: Associated with CREST
: Calcium deposits in hand
: Raynaud’s hand turn white, blue then red
: Esophageal dysfunction = weak
: Sclerodactyly = thickening and tightness on
fingers and toes
: Telangiectasias = dilated cappiliares
= tiny red areas on face,
hands and in mouth
Ortho :
Management : adjust to tolerance, check for instability,
co-manage with rheumatologist
Labs: +Fana , CRP, ESR
Location :
Name Sign : missing distal tuffs on
: looks like lots of white stuffs all around
hands ( Calcium deposits)
Osteotitis condensing Ilia
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA : Osteitis triangularis
Type :
Age : 20-40
Symptom : no symptom
Detail : Multiparous = previously pregnant
: SI joint not involved
: incidental finding, self resolving
Ortho :
Management : trochanteric belt for stability , adjust to
tolerance, check instability Atlanta axial
Labs: no labs
Location : pelvis
Name Sign : Bilateral whitening ( blastic looking) on the
side of the ilium of the SI joint BUT NOT
THE sacrum
degenerative joint disease
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA : Osteoarthritis
Type : Degenerative arhritis
Age :
Symptom : Non- inflammatory
: stiffen on rest and improve with activity
:
Detail : most common on weight bearing joints
Ortho :
Management : adjust to tolerance, educate pt,
glucosamine and chondroitin
Labs: non
Location : weight bearing joints , hands, hip, knee, spine
Name Sign : Spine = IVD narrowing, osteophytes,
endplate sclerosis
= most common c5-c6 on spine
= spinal stenosis
= IVF encroachment
= spurring
Knee = medial joint space decreased with
lateral space preserved
Hip = Decreased super-lateral joint space
with sclerosis
Hand = decreased joint space with
sclerosis, asymmetrical
distribution, non uniform loss of
space
= Heberden’s nodes ( DIP )
Diffuse Idiopathic Skeletal Hyperostosis
AKA :
Type :
Age :
Symptom :
Detail : related to what
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA : Forestier’s dx, Ankylosing hyperostosis
Type : Non-inflamatory arthritis
Age : Over 40
Symptom : spinal pain and stiffness
:
Detail : High correlation with Diabetes Mellitus
Ortho :
Management : adjust, no inflammation and
: educate pt, glucosamine, chondroitin
Labs: fasting blood glucose, AIC glucose
Location :
Name Sign : DISC SPACE MUST be preserved
: Facets never involved
: Candle wax drippings Hyperostosis of 4 or
more continuous segments
: Hyperostosis = too much growth of bone
tissue
= may fuse together making
anterior bridging
: can cause calcification of PLL
Neurogenic arthropathy
AKA :
Type :
Symptom :
Detail : seen with what?
Management :
Location :
Name Sign :
AKA : Charcot’s joint
Type : non-inflammatory arthritis
Age :
Symptom : impaired sensory function on joints
Detail : Seen with diabetes, syphillis, syringomyelia,
tabes dorsals
: 6 D’s = Density, Debris, destruction, distension,
dislocation, disorganization
Ortho :
Management : orthopedist,
Labs:
Location : feet, femur etc
Name Sign : Looks like a bomb exploded on it
: everything is messed up
Synoviochondrometaplasia
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : non inflammatory arthritis
Age : Over 40
Symptom :
Detail : related with OA
:
Ortho :
Management : refer to ortho
Labs:
Location : most common joint affected is knee
Name Sign : looks like popcorn around the joint
: multiple loose bodies in the joint
: round and Ovoid blastic looking in the joint
Gout
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Labs:
Location :
Name Sign :
AKA :
Type : metabolic arthritis
Age : Over 40
Symptom : extremely painful
Detail : NOT in the spine
: Uric acid
: history of high in red meat, red wine, beer , aged
cheese
: goes to the cold areas = toe( podagra ) 70%
ear ( tophi crystals)
: when 1 joint only 70% @ podegra
Ortho :
Management : diet changes, send treatment to
rheumatologist,
: Drugs = acute = colchicine
= chronic = allopurinol
Labs: ESR & uric acid test
: joint aspiration
Location :
Name Sign : Overhanging edge sign = only arthritis to
start from outside and work to get in
: Juxta-articulation erosions = destroy the
bone above and below then destroy the
joint space
Calcium pyrophosphate dihydrate crystal deposition disease
AKA :
Type :
Detail :
Management :
Location :
Name Sign :
AKA : CPPD , pseudogout
Type : Metabolic arthritis
Detail : Chondrocalcinosis = when cartilage affected
Management : rheumatologist, joint aspiration
Location : most common seen in knees
Name Sign : Thin linear calcification parallel to the articular cortex within the joint space
Hdroxyapatite deposition disease
AKA :
Type :
Management :
Location :
Name Sign :
AKA : HADD
Type : metabolic arthritis
Management : co manage rheumatologist, joint aspiration
Location : shoulder joint
Name Sign : Round oval calcification near the insertion
of bursa or tendon
Septic Arthritis
Symptom :
Detail :
Management :
Labs:
Symptom : Fever, chills ,
Detail : history of trauma, surgery w/ warm tender
swollen joint
: staph aureus,
Ortho :
Management : send to ER / infectious dx specialist
Labs: WBC count , culture and sensitivity testing ,
Location :
Name Sign :
Avascular necrosis
AKA: osteonecrosis, osteochondrosis
Major cause of AVN
trauma
Labs for AVN?
none
What can AVN lead to ?
DJD
Special test for AVN?
Bone scan
MRI ( BEST)
manage w/ ortho
are AVN self resolving? if so, how long?
8 months to 2 years
preiser’s
carpal scaphoid
scheurmann’s
vertebral end plate epiphysis
legg calve perthes
femoral epiphysis
kohler’s
tarsal navicular
keinboch’s
carpal lunate
sever’s
calcaneus
blount’s
medial tibial condyle
freigberg’s
head of 2nd and 3rd and 4th metatarsal
osteochondritis dessicans
articular surface of the medial femoral condyle
panner’s
capitellum
Osteochondritis dessicans
Type :
Age :
Symptom :
Ortho :
Management :
Location :
Name Sign :
Type : AVn of femoral condyle
Age : 16-25
Symptom : knee locks out on extension
Ortho : Wilson’s sign
Management : co-manage orthopedist
Location : Knee joint
Name Sign : best seen on tunnel view
radiograph
: Looks like a little fracture on the side of the
knee
Scheurmann’s disease
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Location :
Name Sign :
AKA :
Type : AVN
Age : 10-16
Symptom : Rounded shoulder
: Back pain after lifting
Detail : AVN of the secondary growth center of the
vertebral bodies ( under the endplates)
Ortho :
Management : Stop all physical activity
: thoracic lumbar brace
: adjust
: can lead to early DJD and permanent
postural deformity
Location : spine
Name Sign : must have all 3 below to be considered
: Loss of anterior body height by 10-15%
: multiple endplate irregularities on 3 or
more continuous segments
: Increased kyphosis
Legg calve perthe’s
Type :
Age :
Symptom :
Management :
Location :
Name Sign :
AKA :
Type : AVN for femoral head
Age : 4-9
Symptom : Painless limp , decrease internal rotation
Detail :
Ortho :
Management : Refer to orthopedist for “A” brace
Location : hip, femur head
Name Sign : Crescent sign = fragmentation of femoral
head
: Flattening of femoral head
: Snow capped appearance= increased
white density of the femoral head
: Increased joint space
: Healed = Mushroom capped
Slipped capital femoral epiphysis
AKA :
Type :
Age :
Symptom :
Detail : femoral head and neck movement
Ortho :
Management :
Location :
Name Sign :
AKA : salter Harris type 1 fracture
Type : AVN of hip
Age : 10-16
Symptom : decrease internal rotation, painless limp
Detail : Femoral head slides inferior and medial
: femoral neck slides superior and lateral
Ortho : Klein’s
: shenton’s
: skinner’s
Management : refer to orthopedist
Location : femoral head
Name Sign : Femoral head slides inferior and medial
: femoral neck slides superior and lateral
Congenital hip dysplasia
Type :
Detail :
Ortho :
Name Sign :
Type : AVN of hip
Detail : Putti’s triad
: hypoplastic femoral head
: shallow acetabular shelf
: femoral head outside of acetabulum
Ortho : telecosping
: ortolani’s
: barlow’s
: alli’s
Name Sign
Protrusion acetabula
AKA :
Type :
Age :
Symptom :
Detail :
Ortho :
Management :
Location :
Name Sign :
AKA : Otto if bilateral
Type : AVN of hip
Age :
Symptom :
Detail : axial migration of femoral head with uniform loss
of joint space
: Most often occurs w/ RA
: seen w/ osteoporosis, osteomalacia, Paget’s,
trauma, idiopathic
: obliteration of Kohler’s tear drop
Ortho : Line of mens = Kohler’s
Management :
Location :
Name Sign :
Protrusion acetabula
AKA :
Type :
Detail : associated with what
Ortho :
Location :
Name Sign :
AKA : Otto if bilateral
Type : AVN of hip
Detail : axial migration of femoral head with uniform loss
of joint space
: Most often occurs w/ RA
: seen w/ osteoporosis, osteomalacia, Paget’s,
trauma, idiopathic
: obliteration of Kohler’s tear drop
Ortho : Line of mens = Kohler’s
Location : hip
Name Sign : looks like femur went through the pelvis and went in
Fracture management
: Orthopedist
: RIICE
: Rest, Ice, immobilization, compression, elevation
Avulsion
: portion of bone torn away by muscle or ligament tractional force
comminuted fracture
: with more than 2 fragments
diastasis
: displacement or separationn of a slightly movable joint
compound
: AKA: open fracture
: skin ruptured and bone exposed
Greenstick
: AKA : hickory stick
: incomplete fracture in children
impaction
: bone fragments driven into one another
: bone goes in bone
torus
: AKA : buckling
: incomplete fracture
: one side of the cortex is affected
: bowing of bone
Occult
: clinically evident but not seen on x-ray
: may become evident a week on 10 days later
Stress
: AKA : fatigue
: insufficiency of repetitive stress causing a fracture
Bennett’s
fracture of 1st metacarpal
Boxer’s
fracture of 2nd or 3rd metacarpal
Bar Room
fracture of 4th or 5th metacarpal
Scaphoid
most common fractured carpal bone
Night stick
fracture of the proximal ulna
Montegia ( una si montegia)
Fractured Ulna with radial head displacement
: Una si montegia
Galeazzi
fracture of Distal 1/3 of the radius with dislocation of the distal radio-ulnar joint
C[o]lles
fracture of distal radius with posterior displacement of the distal fragment
Smith’s
fracture of the distal radius with anterior displacement of the distal fragment
March
Stress fracture of the 2nd, 3rd ,or 4th metatarsal
Jones
transverse fracture at the proximal 5th metatarasal
clay shoveler’s
: Avulsion fracture of the spinous process
: MC: @ C6-T1
: Hyperflexion injury
Hangman’s
: bilateral medical fractures of C2
: due to her-extension injury
Jefferson’s bursting
: fractures through the anterior and posterior arches of atlas
: due to axial compression
Ondontoid fracture
fracture of dens
Type 1 Ondontoid fracture
avulsion of the tip of dens
Type 2 Ondontoid fracture
fracture through the base of dens
Type 3 Ondontoid fracture
fracture through body of C2
Tear drop
Associated w what
: avulsion fracture of the anterior inferior aspect of the vertebral body from a hyperextension trauma
: MC @ C2
: associated with acute anterior cervical cord syndrome
: Hyperextension = C2, C3
: Hyperflexion = C4 and down
Salter Harris types
fracture through any growth plate
Salter Harris types type 1
: horizontal fracture through the growth plate
: SCFE
Salter Harris types Type 2
: Growth plate and metaphysis ( Most common) (child abuse)
Salter Harris types Type 3
Growth plate and epiphysis
Salter Harris types Type 4
growth plate, metaphysis and epiphysis
Salter Harris types Type 5
compression deformity of the growth plate ( most severe)
Osgood schlatter’s
: Tibilial apophysitis
: 10-16 yo
:pinpoint pain and swelling
: Use Cho-pat brace
: Lateral x-ray
Rider’s bone
: Avulsion of the ischial tuberosity
: hamstring pull
Chance
Aka
Detail
Mc loc?
: AKA : seatbelt
: horizontal fracture through a single body and posterior arch
: MC @ L1-L3
Spondylolysis
fracture through the pars interarticularis without slippage
spondylolisthesis
slippage of the vertebral body with or without fracture
spondylolisthesis Type 1
: Displastic
: Congenital defect
spondylolisthesis Type 2
: Isthmic
: fracture through pars
spondylolisthesis Type 3
: Degenerative
: DJD of the facet joint
spondylolisthesis Type 4
: traumatic
: fracture through pedicle
spondylolisthesis Type 5
: pathological
: pathology on that segment
What is used to grade spondy?
meyerding’s
1 = up to 25%
2 = 26-50%
3 = 51-75% ( inverted Napoleon hat sign grade 3 or more)
4 = 76-100%
Flexion extension radiographs for stability, special test SPECT
Dislocations
Lunate
: Most commonly dislocated carpal bone
: associated with pie sign
Scaphoid
: Associated with the Terry Thomas sign
: signet ring sign
: Most common fx bone in the hand
Shoulder dislocation
Most common is anterior inferior and medial
Hill sachs
: AKA hachet
: posteriolateral fracture of humeral head
Bankart lesion
: Fracture inferior glenoid labrum
Slap lesion
: Soft lesion of the labrum the superior aspect is torn from anterior to posterior
: diagnosed with MRI
Posterior ponticle
: AKA :
: Detail :
: Location :
: AKA : posticus ponticus
: Detail : Arcuate foramen forms when atlanto-occipital
ligament calcifies
: Transmits the sub-occipital nerve and the
Vertebral artery
: Location : Antlano occipital
Down’s syndrome
:
: Detail :
: Location :
:
: Detail : 20% are born without the transverse ligament.
: increased ADI indicates atlanto axial instability
: must perform stress firms before treatment is
commenced
: Location : Atlanto-axial
Os odontoideum
: AKA :
: Detail : Normally developed cephalic part of the dens
is not fused with the C2 body
: Smooth, wide Lucent defect between the body
of C2 body and dense
: Location : C2
Congenital block
Detail
Associated
Management
: adjacent vertebra osseously fused from birth
: associated with wasp waist and hypo plastic disc
: Adjust above or below segment
Klippel-feil syndrome
: patient presents with a short webbed neck, low hairline, and decreased ROM
: multiple congenital blocks
: associated with sprengle’s deformity and omovertebral bone
Pedicle agenesis
Name sign
How to ddx ?
: Winking owl sign
: Always assume this is lytic met first
: check age if under 40 it is not lytic mets
: check sclerotic change of one above or below
: if non = not lytic mets
: contra lateral pedicle hypertrophy and sclerosis
Butterfly vertebra
failure of the center of the vertebral body to ossify properly
Hemivertebra
: failure of development of a lateral ossification center
: Isolated wedged vertebra causes scoliosis
: associated with gibbous deformity
spinal bifida
: no symptoms
: failure of the laminate fuse
: elevated alpha fetoprotein
: folic acid deficiency
transitional vertebra
Sacralization : L5 TPs may fuse or form joints with
sacrum
: patient will have 4 lumbar
Lumbarization : patient have 6 lumbars
: 1st sacral segment appears like a
lumbar segment
Facet tropism
: asymmetric articular planes
: MC at L5/S1
: best on side posture
knife clasp syndrome
: spina bifida of S1
: L5 spinous enlargement
: Pain on extension
: avoid extension because SP of L5 will hit the caudal equana
Coxa Vara
: End up knock knee
: less than 120*
Coxa Valga
: End up bow legged
: created than 130*
Coxa-femroal angle normal
120-130*
What to measure coxa-femoral angle?
Mikulicz’s line of mensuration
Madelung’s deformity
Bowing of radial shaft w/ increased interosseous membrane
Negative ulnar variance
: ulna is unusually shorter than the radius
: seen with schapho-lunate dislocation
: Lunate dislocation is worse
Pelligrini steida
calcification of the medial collateral ligament
myositis ossificans
: calcification of the muscle belly
: most commonly seen in the biceps and in the quadriceps
: refer to ortho
abdominal aortic aneurysm
Location
Measurement?
Name sign
Test
Management
: Most common location for an aortic aneurysm
: distal to renal artery
: normal abdominal aorta can measure up to 3.8 CM
: more than 3.8 = AAA
: radiographic signs
: aortic dilation
: curvilinear calcification
: fusiform appearance
: Special test: doppler, diagnostic ultrasound,
ultrasonography, CT
: refer to vascular specialist
Cholelithiasis
9f
Pain referral where?
Test?
: Affiliated with the 9 F’s
: Fair, fat, female, fertile, forty, flatulents, fatty stool, fast food
: pain referral to the inferior border of the right scapula ( ciscerosomatic)
: Murphy’s inspiratory arrest
: special test: ultrasound and cholecystogram
Uterine fibroids
: Fibroid cyst/ leiomyoma ( tumor of smooth muscle)
: MC benign tumor in females
Calcified prostate
Age
Labs
Metastasis to where
: over 50 yo
: urinary problems
: Labs: PSA, aci phosphatase
: Metastasis ( MC limbar spine)
: Alkaline phosphatase
:
Phleboliths
: calcification within veins
: Asymptomatic
Fat pads
Location: elbow
: indicates a radial head fracture
: seen on the lateral view
sickle cell anemia
: hair on end appearance on skull
: H shaped vertebra on spine
: collapsed vasculature
thalasemia
: Cooly’s anemia
: mediteranian anemia
: hereditary disorder of hemoglobin synthesis
: microcytic hypochromic anemia
: “Erlenmeyer flash deformity = widened epiphysis
= the femur looks like a erlenmeyer flash
: Hair on end appearance on skull
:
Hyperparathyroidism
: AKA :
: Age : 30-50 yo
: Detail : Over activity of the parathyroid gland
: Calcium Up in blood
: Phosphorus down in blood
: Location : Skull, spine
: name sign : Rugger Jersey spine = looks like a striped
shirt
: Renal Calculi “Brown’s tumor”
: Salt and pepper skull = looks blastic in the
skull
: Labs : Increased alkaline phosphatase
Osteopetrosis
Cause
Detail
Early
Late
: hereditary
: absense of marrow
: Marble bone disease
: Anemia
: hepatosplenomegaly
: Early is Bone within a bone “ Erlenmeyer flash
deformity”
: Late is sandwich vertebra “
Rickets
: Detail : Deficiency of vitamin D, Calcium , or
phosphorus
: Muscle tetany and weakness
: Location : Growth plates in long bones
: Name sign : Bone deformity & lucency
: Paintbrush metaphysis
=absent zone of provisional
calcification
How much better is CT than plain film?
10X
What is best seen when using CT? 11
Fractures
Calficifed soft tissue
Traumatic lesion
pathology
Degenerative changes
anomalies ( Spinal bifida)
Lungs, Abdominal organs, brain
Aneurysms
Brodie’s abscess
Spinal stenosis
lateral recess stenosis
How is CT measured?
house field units
What is best seen on MRI
Meniscus
ligament
tendon
IVD
Spinal cord
meninges
bone
Multiple sclerosis
BEST FOR ALL AVN
How much better is MRI compare to CT
100x
What color is water on
T1 weighted
T2 weighted
T1 = grey
T2 = white t2h20
what color is cortical bone
always black > sigmoid bone
DEXA
Dual emission x-ray absorpmetry
Measures bone density for osteoporosis
Bone scan
: AKA scintigraphy
: injects technetium to measure body’s attempt to make new bone (osteoblastic)
: Hot : AVN
: Blastic
: Lytic
: pagets
: hodgkin
: fractures
: Cold: MM
: Normal is where uptake is usually hot
: Not normal is where increased uptake that is not normally hot
PET SCAN
: AKA : positron emission tomography scan
: Uses a tracer ( Glucose) to find tumor.
: Tumor uses a lot of energy to grow so it will bring all tracer in area of tumor.
: Also shows how effective organs are using the glucose.
