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From CTC Flashcards

1
Q

Mid Carpal dislocation A/W?

A

Triquetro-lunate interosseous lig disruption

Triquetral Fracture

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2
Q

Perilunate A/W

A

scaphoid fracture

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3
Q

Lunate dislocation A/W?

A

(most severe one)

a/w dorsal radiolunate ligament injury

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4
Q

Lig injury with DISI

what is DISI

A

Scapholunate injury (radial sided)

lunate rocks dorsal

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5
Q

Flexor dig’s

which attach where

A

Superficialis - PIP volar plates and base of middle

Profundus - base of distal

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6
Q

ulnar negative variance a/w?

A

Kienbock (lunate AVN)

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7
Q

TFCC injury healing

TFCC tendon

A

peripheral (ulnar side) = red zone, vascular, will heal

ECU

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8
Q

Best view for Hill’s sack

A

INTERNAL ROTATION

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9
Q

posterior disloc locked how?

A

internal rotation

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10
Q

types of shoulder plasty depend on?

A

cuff or glenoid intact?

Both yes = resurfacing or hemi

cuff blown = reverse

cuff and glenoid out = Reverse

Good cuff, bad glenoid = TSA

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11
Q

TSA complx

MC

Reverse complx

A

TSA MC = loosening of glenoid component

anterior escape = subscap failure

Reverse complx = posterior acromion fracture (delt tugging)

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12
Q

MC site for hip labral injury

A

Anterior superior

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13
Q

leg fixed how in posterior hip disloc

A

foot internally rotated

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14
Q

hip fracture and AVN, risk depends on?

A

degree of displacement

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15
Q

Segond

A

lateral

joint capsule avulsion fx

ACL

internal rotation

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16
Q

Reverse segond

A

medial

PCL

external rotation

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17
Q

arcuate sign/fx

A

avulsion of prox fibula

PCL

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18
Q

intercondylar notch sign

A

LATERAL condyle

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19
Q

patella alta a/w?

A

SLE

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20
Q

Pilon fx

A

comminuted and intra-articular

talus driven into tibial plafond

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21
Q

Tillaux

A

Salter 3 of lateral distal tibia

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22
Q

Triplane

A

think 3 parts so Salter 4

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23
Q

5th metatarsal fractures

A

Stress more distal than Jones

avulsion most proximal (peroneus brevis)

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24
Q

No trauma medial femoral condyle edema?

A

SONK (actually a insufficiency fracture)

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25
Q

osteomalacia etiology/histology

A

excessive, uncalcified osteoid

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26
Q

osteomal = looser zones

where

what

A

femoral neck and pubic rami

symmetric, lucency with adjacent sclerosis

90 degrees to cortex

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27
Q

Synovial/joint spaces that communicate

wrist

A

Pisiform recess and radiocarpal joint

piss fluid is normal

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28
Q

Synovial/joint spaces that communicate or don’t?

Shoulder

A

Glenohumeral joint and subacromial bursa

DONT communicate. fluid in the bursa = cuff tear

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29
Q

Synovial/joint spaces that communicate

Ankle

A

Ankle joint and peroneal tendon sheath

SHOULD NOT

= Tear of calcaneofibular ligament

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30
Q

Intersecting syndrome

what crosses what

tenosynovitis of what

A

first crossing over second (extensor compartments)

ECR longus and brevis

(If you remember this you deserve Extra CRedit)

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31
Q

Tenosynovitis

Diffuse or focal

A

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
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32
Q

Dupuytren contracture

“classics” to the story

A

Northern European alky

nodular mass on palmar aspect of aponeurosis –> ‘cord-like thickening’ and contracture

Usually 4th finger

half bilateral

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33
Q

Glomus finger tumor

A

benign, vascular, hamartoma

PAINFUL

T2 bright

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34
Q

GCT of tendon sheath

A

PVNS of tendon

T1 and T2 dark

bloom on GRE

No bloom = fibroma

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35
Q

UCL tear

A

valgus overload

attaches to sublime tubercle

anterior bundle most important

T sign

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36
Q

Tennis elbow

A

Lateral epicondylitis

ECRB

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37
Q

Golf elbow

A

medial

common flexor tendon and ulnar nerve chronic injury

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38
Q

classic for cat scratch

A

epitrochlear LAD

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39
Q

AC joint separation

?ligaments

A

acromioclav and coracoclav

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40
Q

External impingement

A

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

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41
Q

Internal impingement

A

posterior superior- overhead movements, ABER view

Greater tuberosity and posterior inferior labrum do the pinching

anterior superior - biceps and subscap tendons

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42
Q

Frozen shoulder MRI look

A

loss of fat in the rotator cuff interval (by biceps tendon, btw supra-s and sub-scap)

interval also enhances

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43
Q

SLAP

type IV

stable?

mechanism?

A

Typer 4 involves long head biceps tendon

Not usually unstable

a/w overhead movement

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44
Q

sublabral recess

sublabral foramen

A

recess - mimics SLAP, points towards head

foramen, unattached labrum from 1 to 3 o’clock

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45
Q

HAGL

A

humeral avulsion glenohumeral ligament

anterior dislocation related

avulsion of inferior glenohumeral ligament

torn and ‘J-shaped’ retracted from humerus

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46
Q

biceps tendon sublux

A

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

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47
Q

Magic angle

A

Short TE (T1, PD, GRE)

PCL and patellar tendons

foci of intermediate signal

55 degrees

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48
Q

Meniscal tears

A

Vertical = radial or longitudinal

Horizontal

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49
Q

Bucket handle tear

A

usually medial

flips anterior ‘double PCL’

indirectly proves ACL is intact. Wont get double PCL with a torn ACL

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50
Q

ACL kissing contusions

A

lateral fem condyle and posterolat tibial plateau

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51
Q

ACL repair ‘roof impingement’

‘isometry’

A

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

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52
Q

ACL repair graft tear

when

look

A

During remodeling (4-8 months)

increased T2 signal

53
Q

Ankle avulsions

above/lateral to lateral mal

medial/below lateral mal

A

above/lat = superior peroneal retinaculum avulstion

medial/below = ATFL/calcaneofib

54
Q

inversion ankle injury

A

ATFL

55
Q

primary arch stabilizer

acute injury where

chronic injury where

A

PTT

acute at navicular insertion

chronic behind medial mal

56
Q

Chronic ankle pain, h/o inversion injuries

A

split peroneus brevis

C shaped, or boomerang or 3 tendons

57
Q

Anterolateral impingement

A

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

58
Q

tarsal tunnel

A

1st three toes, tibial nerve

tunnel behind med mal

usually unilateral

59
Q

medial clear space ligament

A

delt

60
Q

Morton

where

look

A

bt 3rd and 4th metatarsal heads

scar, perineural fibrosis T1 dark

entrapment of plantar digital nerve by intermetatarsal ligament

61
Q

Osteomyelitis factoids in kids

< 1 month

< 18 months

2-16 years

A

< 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

62
Q

Potts look

A

spares disc

multiple levels

large, calcified psoabscesses

Gibbus = destructive focal kyphosis

63
Q

Rice bodies

A

sloughed infarcted synovium a/w end stage RA and TB infection of joints

64
Q

TB fingers

A

kids

TB dactylitis

smoldering, no PO reaction

diaphyseal expansile lesion with soft tissue swelling

65
Q

paro vs peri

location

age

A

parosteal usually metaphyseal

peri tends to be diaphyseal

peri = younger (15-25)

66
Q

Chondrosarc RF

A

Pagets

maffuccis

osteochondromas (peripheral. others intramedullary)

67
Q

epiphyseal lucent

kid vs adult

A

kid maybe chondroblastoma (thin sclerotic rim)

Adult think clear cell chondrosarcoma (usually bigger)

68
Q

permeative dyaphyseal lesion in a kid

A

EWINGS

infection

EG

69
Q

Ewings

A

skipping white kid

mets to bone, whites, kids

70
Q

MFH (PUS)

who

where

look

complx

A

old people

central (proximal arms and legs)

T2 dark

spontaneous hemorrhage –> hematoma

71
Q

Synovial sarcoma

look

location

MC malignancy in teens/young adults of foot/ankle/lower ext

A

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

72
Q

Young person liposarc variant

A

myxoid liposarc

MC liposarc < 20 y

T1 dark T2 bright (LOOK LIKE A CYST)

will enhance

73
Q

hemangioma

unique shit

A

phleboliths (get an xray)

flow voids

74
Q

mazabraud

A

Polyost fibrous dysplasia with soft tissue myxomas

75
Q

Unique tx

O’sarc

Ewing

Chondrosarc

GCT

A

O’sarc - chemo then wide excision

Ewing - chemo and RT then excision

Chondrosarc - Just excision

GCT - Usually needs arthroplasty (extends to articular surface)

76
Q

benign parost mimic

A

Cortical desmoid

(posterior distal femur)

can be hot on bone scan

77
Q

Four horsemen of the apophysis

A

ABC (crosses closed growth plate)

Infx

Giant cell

Chondroblastoma

78
Q

Epiphyseal equivalents

A

patella

calcaneus

carpals

greater troch

79
Q

fibrous dysplasia

mono vs poly age

look

A

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

80
Q

FD femur

A

shepherd’s crook

FD of pelvis also involves ipsi femur

81
Q

2 polyostotic fibrous dysplasia syndromes

A

McCune Albright - girl, precocious puberty

Mazabroud - myxomas and risk of malig transformation

82
Q

weird look for EG

A

floating tooth

lyitc lesion in alveolar ridge

83
Q

GCT needs

a/w lesion

?mets

A

closed physis (20-30 yo)

ABC

lung mets (curable)

84
Q

GCT vs NOF

A

GCT NON sclerotic border

NOF sclerotic

85
Q

lytic or sclerotic with hyperparathyroidism

what

where

A

Brown tumor

side of a finger

under clavicle

under a rib

86
Q

CMF

A

eccentric, lytic metaphyseal,

BITE configuration

looks like a NOF kinda

87
Q

HIP COMMONS by spot

GREATER

LESSER

INTER

A

Greater = AIGC

LESSER = pathologic avulsion

INTER = Lipoma, unicameral, monostotic fibrous dysplasia

88
Q

POEMS

A

myeloma with sclerotic mets

with neuropathy and organomegaly

89
Q

calcaneal lesion with central calc

A

lipoma

90
Q

random intertroch lytic lesion with a sclerotic margin

A

liposclerosing myxofibroma

91
Q

coxa profunda

A

deep tab

vs protrusio

92
Q

worrisome cap size

A

> 1.5 cm

93
Q

bilateral weird, enlarged prox femurs =

A

mult hered exostoses, sessile

coxa magna

94
Q

avian spur possible complx

points toward joint

o’chondromas point away

A

median nerve compression

ligament of struthers

95
Q

adamantinoma look alike (same thing?)

A

osteofibrous dysplasia

anterior tibia, bowing

looks like a NOF

96
Q

oa vs ra tab

A

OA straight up or straight medial

RA DIAGONAL IN

97
Q

Reiters basic look

A

psoriatic usually sparing hands

SI joints and feet

98
Q

Ank spond goes where first

A

SI joints

(then spine)

99
Q

non spine/SI ank spond?

A

hips > shoulders

horrible heterotopic ossification after hip replacements

100
Q

Ank spond associations

A

uveitis

upper lung interstitial dz (cysts and fibrosis)

aortic insufficiency

101
Q

MC ank spond fx site?

A

lower C spine

102
Q

CPPD things

A

chondrocalcinosis

Loves TFCC

unusual joints (radiocarpal, shoulder, elbow, patellofemoral)

hooked phytes (also with Fe)

can cause SLAC

103
Q

CPPD vs Fe

A

BOTH chondrocalcinosis

BOTH hooked phytes

Fe at ALL THE MCP’s

CPPD INDEX and MIDDLE

104
Q

hyperparathyroidism looks

A

radial sided resorption

tuft resorption

brown tumors

rugger spine

105
Q

Dens erosions

A

CPPD and RA

106
Q

Like SLE hands?

A

Jacoud

non erosive

ulnar sublux of 2nd -5th at MCP

POST RHEUMATIC FEVER

107
Q

spine of HD patient x 2 years

A

Destructive Spondyloarthropathy

ugly C spine

2/2 amyloid deposition

108
Q

Juvenile idiopathic RA

A

jacked up carpals <16 yo

negative serology

epiphyseal overgrowth

widened intercondylar notch

109
Q

long term HD ‘itis

A

Amyloid arthropathy

bilateral shoulders, hips, carpals, knees - severe destruction

carpal tunnel

joint spaces preserved until later

110
Q

THA degen

A

along diag axis (the RA one) = creep = normal

wear = abnormal = superior-lateral

111
Q

Red marrow persists where in adulthood

A

axial skeleton and proximal metaphyses of prox long bones

112
Q

poikylosis

A

bone islands that favor epiphyses

peri-articular

keloid formers

113
Q

Engelmann’s

A

progressive diaphyseal dysplasia

fusiform long-bone boney enlargement with sclerosis

bilateral

symmetric

usually tibia

bone scan hot

skull –> optic nerve compression

114
Q

PVNS

where

what

A

joint synovium or tendon sheath

synovial prolif and Fe deposition

knee by far MC

115
Q

PVNS look

A

xray - joint effusion +/- marginal erosions

joint space preserved

normal mineralization

MRI BLOOMING on GRE

116
Q

PVNS tx?

A

complete synovectomy

117
Q

PVNS in the hand

A

GCT of tendon sheath

erosions

T1 and T2 dark

glomus T2 bright and avid enhancement

118
Q

mutiple uniform ring and arc calc joint bodies

A

primary synovial chondromatosis

  • true neoplasia/metaplasia

tx = scope and remove +/- synovectomy

PVNS never calcifies

119
Q

Gigantism mechanism

A

formation of endochondral bone at existing chondro-osseous junctions

—> widening of osseous structure

120
Q

AVN rim sign

A

T2 oreo with bright fluid between sclerotic borders of an osteochondral fragment

stage III instability

121
Q

Pagets 3 phases

A

lytic - asymp

mixed - fractures, elevated alk phos

sclerotic - more fractures and cancer

122
Q

Pagets look

A

wide bones with thick trabecula

123
Q

pagets in a long bone

A

lytic

blade of grass

lucent leading edge

124
Q

Pagets spine, skull

A

Picture frame

tam o shanter thick skull

125
Q

Pagets complications

A

MC = Deafness

Spinal stenosis

stress fractures

CHF

2ary hyperparathyroidism

alk phos way way elevated

126
Q

Pagets tx

A

bisphosphonates

127
Q

Pagets skull look

A

lytic = frontal and occipital (circumscripta)

mixed = cotton wool

involves both inner and outer tables

FD just outer

128
Q

normal coracoclav distance

A

1.3 cm

129
Q

subscap insertion

A

lesser tuberosity

msk (1 decks)

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