From CTC Flashcards
Mid Carpal dislocation A/W?
Triquetro-lunate interosseous lig disruption
Triquetral Fracture
Perilunate A/W
scaphoid fracture
Lunate dislocation A/W?
(most severe one)
a/w dorsal radiolunate ligament injury
Lig injury with DISI
what is DISI
Scapholunate injury (radial sided)
lunate rocks dorsal
Flexor dig’s
which attach where
Superficialis - PIP volar plates and base of middle
Profundus - base of distal
ulnar negative variance a/w?
Kienbock (lunate AVN)
TFCC injury healing
TFCC tendon
peripheral (ulnar side) = red zone, vascular, will heal
ECU
Best view for Hill’s sack
INTERNAL ROTATION
posterior disloc locked how?
internal rotation
types of shoulder plasty depend on?
cuff or glenoid intact?
Both yes = resurfacing or hemi
cuff blown = reverse
cuff and glenoid out = Reverse
Good cuff, bad glenoid = TSA
TSA complx
MC
Reverse complx
TSA MC = loosening of glenoid component
anterior escape = subscap failure
Reverse complx = posterior acromion fracture (delt tugging)
MC site for hip labral injury
Anterior superior
leg fixed how in posterior hip disloc
foot internally rotated
hip fracture and AVN, risk depends on?
degree of displacement
Segond
lateral
joint capsule avulsion fx
ACL
internal rotation
Reverse segond
medial
PCL
external rotation
arcuate sign/fx
avulsion of prox fibula
PCL
intercondylar notch sign
LATERAL condyle
patella alta a/w?
SLE
Pilon fx
comminuted and intra-articular
talus driven into tibial plafond
Tillaux
Salter 3 of lateral distal tibia
Triplane
think 3 parts so Salter 4
5th metatarsal fractures
Stress more distal than Jones
avulsion most proximal (peroneus brevis)
No trauma medial femoral condyle edema?
SONK (actually a insufficiency fracture)
osteomalacia etiology/histology
excessive, uncalcified osteoid
osteomal = looser zones
where
what
femoral neck and pubic rami
symmetric, lucency with adjacent sclerosis
90 degrees to cortex
Synovial/joint spaces that communicate
wrist
Pisiform recess and radiocarpal joint
piss fluid is normal
Synovial/joint spaces that communicate or don’t?
Shoulder
Glenohumeral joint and subacromial bursa
DONT communicate. fluid in the bursa = cuff tear
Synovial/joint spaces that communicate
Ankle
Ankle joint and peroneal tendon sheath
SHOULD NOT
= Tear of calcaneofibular ligament
Intersecting syndrome
what crosses what
tenosynovitis of what
first crossing over second (extensor compartments)
ECR longus and brevis
(If you remember this you deserve Extra CRedit)
Tenosynovitis
Diffuse or focal
Diffuse
- Non-TB mycobacterial - hand and wrist MC, diffuse and exuberant, spares the muscles, immunocompromised
- RA - multiple flexor tendons or ECU (can be very early RA)
Focal
- Overuse (DQ’s)
- Infection - involvement of a flexor surgical emergency
Dupuytren contracture
“classics” to the story
Northern European alky
nodular mass on palmar aspect of aponeurosis –> ‘cord-like thickening’ and contracture
Usually 4th finger
half bilateral
Glomus finger tumor
benign, vascular, hamartoma
PAINFUL
T2 bright
GCT of tendon sheath
PVNS of tendon
T1 and T2 dark
bloom on GRE
No bloom = fibroma
UCL tear
valgus overload
attaches to sublime tubercle
anterior bundle most important
T sign
Tennis elbow
Lateral epicondylitis
ECRB
Golf elbow
medial
common flexor tendon and ulnar nerve chronic injury
classic for cat scratch
epitrochlear LAD
AC joint separation
?ligaments
acromioclav and coracoclav
External impingement
Primary =
coracoacromial arch
hooked acromion, subacromial o’phyte, subcoracoid (impinges on subscap, first two on suprascap)
Secondary =
multidirectional glenohumeral instability (microtrauma in all directions) lax joint
Internal impingement
posterior superior- overhead movements, ABER view
Greater tuberosity and posterior inferior labrum do the pinching
anterior superior - biceps and subscap tendons
Frozen shoulder MRI look
loss of fat in the rotator cuff interval (by biceps tendon, btw supra-s and sub-scap)
interval also enhances
SLAP
type IV
stable?
mechanism?
Typer 4 involves long head biceps tendon
Not usually unstable
a/w overhead movement
sublabral recess
sublabral foramen
recess - mimics SLAP, points towards head
foramen, unattached labrum from 1 to 3 o’clock
HAGL
humeral avulsion glenohumeral ligament
anterior dislocation related
avulsion of inferior glenohumeral ligament
torn and ‘J-shaped’ retracted from humerus
biceps tendon sublux
subscap attaches to lesser tuberosity
sends some fibers over bicipital groove to greater tuberosity as the transverse ligament
subscap tear –> medial disloc of long head tendon
Magic angle
Short TE (T1, PD, GRE)
PCL and patellar tendons
foci of intermediate signal
55 degrees
Meniscal tears
Vertical = radial or longitudinal
Horizontal
Bucket handle tear
usually medial
flips anterior ‘double PCL’
indirectly proves ACL is intact. Wont get double PCL with a torn ACL
ACL kissing contusions
lateral fem condyle and posterolat tibial plateau
ACL repair ‘roof impingement’
‘isometry’
tibial tunnel too far anterior = impingement
tibial tunnel = primary factor in preventing impingement
isometry = constant length and tension of graft
primary factor for isometry = femoral tunnel
ACL repair graft tear
when
look
During remodeling (4-8 months)
increased T2 signal
Ankle avulsions
above/lateral to lateral mal
medial/below lateral mal
above/lat = superior peroneal retinaculum avulstion
medial/below = ATFL/calcaneofib
inversion ankle injury
ATFL
primary arch stabilizer
acute injury where
chronic injury where
PTT
acute at navicular insertion
chronic behind medial mal
Chronic ankle pain, h/o inversion injuries
split peroneus brevis
C shaped, or boomerang or 3 tendons
Anterolateral impingement
mass of hypertrophic synovial tissue from ATFL and tibiofibular ligament injury causing lateral instability and chronic inflammation T1 and T2 dark mass in lateral ankle
tarsal tunnel
1st three toes, tibial nerve
tunnel behind med mal
usually unilateral
medial clear space ligament
delt
Morton
where
look
bt 3rd and 4th metatarsal heads
scar, perineural fibrosis T1 dark
entrapment of plantar digital nerve by intermetatarsal ligament
Osteomyelitis factoids in kids
< 1 month
< 18 months
2-16 years
< 1 month multicentric, often involve joints, bone scan negative
< 18 months spreads to physis through blood
2-16 years > physeal vessels closed, growth plate is a barrier, hangs out in metaphysis
Potts look
spares disc
multiple levels
large, calcified psoabscesses
Gibbus = destructive focal kyphosis
Rice bodies
sloughed infarcted synovium a/w end stage RA and TB infection of joints
TB fingers
kids
TB dactylitis
smoldering, no PO reaction
diaphyseal expansile lesion with soft tissue swelling
paro vs peri
location
age
parosteal usually metaphyseal
peri tends to be diaphyseal
peri = younger (15-25)
Chondrosarc RF
Pagets
maffuccis
osteochondromas (peripheral. others intramedullary)
epiphyseal lucent
kid vs adult
kid maybe chondroblastoma (thin sclerotic rim)
Adult think clear cell chondrosarcoma (usually bigger)
permeative dyaphyseal lesion in a kid
EWINGS
infection
EG
Ewings
skipping white kid
mets to bone, whites, kids
MFH (PUS)
who
where
look
complx
old people
central (proximal arms and legs)
T2 dark
spontaneous hemorrhage –> hematoma
Synovial sarcoma
look
location
MC malignancy in teens/young adults of foot/ankle/lower ext
Easily mistaken for a Baker cyst
peripheral, near joints
complex, flow
bowl of grapes, diff signals, calcs
CAN attack bones (other sarcs don’t)
HURT (other sarcs don’t)
Bony erosions, slow growing
Young person liposarc variant
myxoid liposarc
MC liposarc < 20 y
T1 dark T2 bright (LOOK LIKE A CYST)
will enhance
hemangioma
unique shit
phleboliths (get an xray)
flow voids
mazabraud
Polyost fibrous dysplasia with soft tissue myxomas
Unique tx
O’sarc
Ewing
Chondrosarc
GCT
O’sarc - chemo then wide excision
Ewing - chemo and RT then excision
Chondrosarc - Just excision
GCT - Usually needs arthroplasty (extends to articular surface)
benign parost mimic
Cortical desmoid
(posterior distal femur)
can be hot on bone scan
Four horsemen of the apophysis
ABC (crosses closed growth plate)
Infx
Giant cell
Chondroblastoma
Epiphyseal equivalents
patella
calcaneus
carpals
greater troch
fibrous dysplasia
mono vs poly age
look
mono 20s and 30s
poly < 10 yo
disorder of o’blasts
variable with phases
long lesion, long bone, ground glass
no pain or perio rxn
FD femur
shepherd’s crook
FD of pelvis also involves ipsi femur
2 polyostotic fibrous dysplasia syndromes
McCune Albright - girl, precocious puberty
Mazabroud - myxomas and risk of malig transformation
weird look for EG
floating tooth
lyitc lesion in alveolar ridge
GCT needs
a/w lesion
?mets
closed physis (20-30 yo)
ABC
lung mets (curable)
GCT vs NOF
GCT NON sclerotic border
NOF sclerotic
lytic or sclerotic with hyperparathyroidism
what
where
Brown tumor
side of a finger
under clavicle
under a rib
CMF
eccentric, lytic metaphyseal,
BITE configuration
looks like a NOF kinda
HIP COMMONS by spot
GREATER
LESSER
INTER
Greater = AIGC
LESSER = pathologic avulsion
INTER = Lipoma, unicameral, monostotic fibrous dysplasia
POEMS
myeloma with sclerotic mets
with neuropathy and organomegaly
calcaneal lesion with central calc
lipoma
random intertroch lytic lesion with a sclerotic margin
liposclerosing myxofibroma
coxa profunda
deep tab
vs protrusio
worrisome cap size
> 1.5 cm
bilateral weird, enlarged prox femurs =
mult hered exostoses, sessile
coxa magna
avian spur possible complx
points toward joint
o’chondromas point away
median nerve compression
ligament of struthers
adamantinoma look alike (same thing?)
osteofibrous dysplasia
anterior tibia, bowing
looks like a NOF
oa vs ra tab
OA straight up or straight medial
RA DIAGONAL IN
Reiters basic look
psoriatic usually sparing hands
SI joints and feet
Ank spond goes where first
SI joints
(then spine)
non spine/SI ank spond?
hips > shoulders
horrible heterotopic ossification after hip replacements
Ank spond associations
uveitis
upper lung interstitial dz (cysts and fibrosis)
aortic insufficiency
MC ank spond fx site?
lower C spine
CPPD things
chondrocalcinosis
Loves TFCC
unusual joints (radiocarpal, shoulder, elbow, patellofemoral)
hooked phytes (also with Fe)
can cause SLAC
CPPD vs Fe
BOTH chondrocalcinosis
BOTH hooked phytes
Fe at ALL THE MCP’s
CPPD INDEX and MIDDLE
hyperparathyroidism looks
radial sided resorption
tuft resorption
brown tumors
rugger spine
Dens erosions
CPPD and RA
Like SLE hands?
Jacoud
non erosive
ulnar sublux of 2nd -5th at MCP
POST RHEUMATIC FEVER
spine of HD patient x 2 years
Destructive Spondyloarthropathy
ugly C spine
2/2 amyloid deposition
Juvenile idiopathic RA
jacked up carpals <16 yo
negative serology
epiphyseal overgrowth
widened intercondylar notch
long term HD ‘itis
Amyloid arthropathy
bilateral shoulders, hips, carpals, knees - severe destruction
carpal tunnel
joint spaces preserved until later
THA degen
along diag axis (the RA one) = creep = normal
wear = abnormal = superior-lateral
Red marrow persists where in adulthood
axial skeleton and proximal metaphyses of prox long bones
poikylosis
bone islands that favor epiphyses
peri-articular
keloid formers
Engelmann’s
progressive diaphyseal dysplasia
fusiform long-bone boney enlargement with sclerosis
bilateral
symmetric
usually tibia
bone scan hot
skull –> optic nerve compression
PVNS
where
what
joint synovium or tendon sheath
synovial prolif and Fe deposition
knee by far MC
PVNS look
xray - joint effusion +/- marginal erosions
joint space preserved
normal mineralization
MRI BLOOMING on GRE
PVNS tx?
complete synovectomy
PVNS in the hand
GCT of tendon sheath
erosions
T1 and T2 dark
glomus T2 bright and avid enhancement
mutiple uniform ring and arc calc joint bodies
primary synovial chondromatosis
- true neoplasia/metaplasia
tx = scope and remove +/- synovectomy
PVNS never calcifies
Gigantism mechanism
formation of endochondral bone at existing chondro-osseous junctions
—> widening of osseous structure
AVN rim sign
T2 oreo with bright fluid between sclerotic borders of an osteochondral fragment
stage III instability
Pagets 3 phases
lytic - asymp
mixed - fractures, elevated alk phos
sclerotic - more fractures and cancer
Pagets look
wide bones with thick trabecula
pagets in a long bone
lytic
blade of grass
lucent leading edge
Pagets spine, skull
Picture frame
tam o shanter thick skull
Pagets complications
MC = Deafness
Spinal stenosis
stress fractures
CHF
2ary hyperparathyroidism
alk phos way way elevated
Pagets tx
bisphosphonates
Pagets skull look
lytic = frontal and occipital (circumscripta)
mixed = cotton wool
involves both inner and outer tables
FD just outer
normal coracoclav distance
1.3 cm
subscap insertion
lesser tuberosity