Image Interp Pathos Flashcards
Finger Dorsal Avulsion #
Forced flexion at IPJ
B- Extensor tendon insertion
Base of phalanx
Dorsal aspect
A - Mallet deformity
Finger Volar Avulsion #
Forced extension at IPJ
Dislocation
S - Localised ST swelling
B - Flexor tendon insertion
Base of phalanx
Volar plate
A - persistent dislocation/subluxation
Collateral avulsion # (skiers’ / gamekeepers’ thumb)
Abduction/adduction
Dislocation
S - Localised ST swelling
B - Collateral ligament insertion
Base of phalanx
Medial or lateral
A - persistent dislocation/subluxation
Paed hand #
‘Zone of hypertrophy’
Hyperextension (commonly
S - Localised ST swelling
B - Incomplete #’s
SH II #’s
Base proximal phalanges
MC necks
OA Hand
Primary (Familial)
Secondary (Abnormal mechanical forces)
Age
S - Localised soft tissue swelling
Joint effusions B - Osteophytes
Subchondral sclerosis Subchondral cysts/geodes
A - asymmetric joint space narrowing
RA
Chronic autoimmune inflammatory
disease
Synovial tissues and joints as well as
other systems
Adult onset (usually)
Female predominance
S - Fusiform and peri-articular ST swelling
B - Marginal erosions
Juxta-articular osteoporosis
Large subchondral cysts (late)
A - Symmetrical/concentric joint space
narrowing
Subluxations (ulnar deviation)
Boutonniere & swan neck
Supracondylar #
FOOSH - hyperextension
Direct blow or fall on the flexed elbow
(adult)
+/- vascular damage (brachial artery)
S - Localised ST swelling
+/- elevated fat pads
B - Transverse # proximal to condyles
Dorsal displacement (common)
Anterior displacement (less common)
Radial head and neck break #
FOOSH
S - Elevated fat pads (head)
+/- elevated fat pads (neck)
B - Longitudinal intra-articular # (head)
Transverse extra-articular # (neck)
Elbow Dislocation
FOOSH - Hyperextension elbow
S - ST swelling and deformity ** often no effusion ** B - +/- coronoid process #
+/- radial head #
+/- medial epicondyle avulsion
A - Dorsal or dorso-lateral dislocation of
forearm (most common)
Medial epicondyle avulsion #
Dislocation - elbow
Valgus force
S - Localised medial ST swelling
B - Avulsion # medial epicondyle or
secondary ossification centre
A - Intra-articular location of medial
epicondyle post reduction
Paired fractures - forearm
Fall
- Diffuse ST swelling & deformity B - Mid-shaft #’s
Angulation or displacement (most
common dorsal)
+/- Plastic deformity (paeds)
Isolated ulna #
Defence injury
Direct impact
Fixed flexed elbow
S - Localised ST swelling
B - Undisplaced, transverse mid-shaft #
Ulna #-dislocation (Monteggia)
Fall on hyperextended arm
Posterior blow to extended elbow
S - Diffuse ST swelling and deformity B - Angulated # of proximal 1/3 ulna
A - Anterior dislocation of proximal radius
Radial #-dislocation (Galeazzi)
FOOSH
S - Diffuse ST swelling and deformity B - Angulated # of distal 1/3 radius
A - Disruption/dislocation of distal
radioulnar joint
Clav #
Direct blow (most common)
FOOSH
S - ST swelling & deformity B - Mid-shaft #’s (80%)
+/- Angulation or displacement
(Can be subtle)
Rote. Cuff dysfunction
Chronic - Impingement subacromial space
Acute
S - ST calcifications
B - Features of OA in ACJ/GHJ
A - ‘high riding’ humerus - Reduced
subacromial space
+/- subacromial erosion
Humeral head and neck #
FOOSH (elderly majority) Major trauma (25-45 yrs)
Direct impact
Dislocation
S - ST swelling +/- deformity
Lipohaemarthrosis (intracapsular)
B - 85% undisplaced Surgical/anatomical
neck
+/- comminution
Isolated tuberosity # (direct impact)
A - Dislocation with avulsion GT
Ant shoulder D/C
Forced Ext. rote and abduction
S - Gross deformity
B - # humeral head +/- glenoid
A - Antero-infer-medial displacement of
humeral head in relation to glenoid (subcoracoid)
Post shoulder D/C
Posterior movement of internally rotated
arm
Electrocution
Seizure
S - Potentially nil
B - Light bulb
A - ‘Naked glenoid’ Joint incongruence
ACJ D/C
FOOSH
Direct impact/fall tip shoulder
- Diffuse ST swelling +/- deformity B - nil
A - Widening of ACJ and CCJ
Glenoid #
D/C
S - nil (on x-ray)
Considerable ST injury to glenoid labrum
(MR)
B - Anterior/posterior/inferior bone
fragment
A - nil (post reduction most useful)
Foot avulsion #
Inversion
S – ST swelling lateral foot
B - # 5th MT Base (transverse)
A – nil
SS – Don’t confuse for apophysis
Midfoot #-dislocation (Lisfranc injury)
High velocity trauma (e.g. MVC) Forced plantar flexion/axial load
S – ST swelling dorsum foot
B - # 2nd MT Base +/- others
A – Widening of 1st IMTJ
Divergent or homolateral MT displacement
Calcaneal #
Axial loading/ Fall from height
S – ST swelling plantar aspect foot
B - # may be subtle (Boehler’s angle) Often intra-articular #’s
SS – Exclude L1 # -> ?
Foot stress #
S – nil
B – often nil
A - nil
SS – periosteal reaction MT shaft
Isolated fibular #
Direct impact Equivalent to defence # of the ulna
S - Localised ST swelling
B - Transverse (or gently oblique) # Undisplaced
+/- butterfly fragment
A - Nil
Paired #’s Lower leg
Twisting injury Direct Impact
S - Localised ST swelling
Limb deformity
B - Spiral # at different levels (twist) Transverse/oblique # at same level (direct) A - Nil
Crush injury (lower Limb)
S - Extensive ST injury
Limb deformity Subcutaneous emphysema
B - Comminuted Compound (often)
A - Exclude associated joint disruption
Toddler #
Fall
(Toes gripping the floor)
S - Localised ST swelling
B - Oblique/spiral # tibia Undisplaced
Patella #
Direct trauma
Forceful quadriceps contraction
S - Localised ST swelling
Joint effusion or lipohaemarthrosis B - Transverse
Stellate
Avulsion
Tibial plateau #
Axial compression Abduction/adduction
S - Localised ST swelling Lipohaemarthrosis
B - Uni-condylar Intra-articular
Exclude displacement or depression
Avulsion # knee
Tension in one or more of the ligaments and tendons around the knee
S - Localised ST swelling
+/- joint effusion or lipohaemarthrosis B - Cortical avulsion fragments Origin/insertion
Perthes disease
diopathic osteonecrosis proximal femoral epiphysis
Rare
Boys > Girls
Age 5-6 (ish)
Younger than slipped epiphysis
S - Joint effusion (Subtle. US better)
B - Reduction in size epiphysis
Crescent sign (subchondral) Increased density
Fragmentation
Prox femur #
Fall
S - nil
B -Cortical break and lucent line or Subtle sclerotic band Undisplaced or grossly displaced
Slipped upper/capital femoral epiphysis (SUFE/SCFE)
Chronic slip
Acute - sudden deceleration Hip +/- knee pain Bilateral common ‘Pickwickian’ Boy 11-14
S - Joint effusion
B - SH I Postero-medial slip femoral epiphysis ‘Narrowing’ of epiphysis
Paget disease of bone
Unknown
Western predominance Men>women (slight) Osteoclast disease Pelvis/femur/skull spine Malignant dedifferentiation (rare)
S - nil
B - Enlargement of bones Cortical thickening Coarsened trabeculae A - Acetabular protrusion
2 types of lesion pattern of destruction
geographic
Moth eaten/ premeative
2 Types of zone of transition
narrow
Wide
Host response
Cortical thinning / expansion
Periosteal reaction
Codman’s triangle
