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MSK Flashcards

1
Q

1 primary benign bone lesion

A

osteochondroma

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2
Q

causes osteonecrosis/AVN

A
  • idiopathic (37%)
  • steroids (35%)
  • alcoholism (22%)
  • trauma
  • hemoglobinopathy
  • collagen vascular disease
  • dysbaric disorder
  • gaucher
  • pregnancy
  • radiation
  • pancreatitis
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3
Q

osteonecrosis pathology progression

A

zone of cell death centrally

  • hematopoietic elements 6-12 hrs
  • bone cells 12-48 hrs
  • marrow fat cells 48 hrs - 5 days

zone of ischemic injury

  • creeping substitution
  • reinforcing trabecular bone
  • marrow reaction

N bone marrow

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4
Q

normal alpha angle adult

A

~40

≥55 abN (CAM impingement)

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5
Q

normal centre edge angle

A

N <39 degrees

increased = pincer
decreased = ddh
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6
Q

osteopoikilosis - bone scan features

A

cold

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7
Q

osteopoikilosis - bone segment prediliction

A

epiphyses & metaphyses

and carpus, tarsus, pelvis

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8
Q

most common site osteoma

A

frontoethmoid sinus region (75%)

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9
Q

genetic association multiple osteomas

A

gardner syndrome (APC gene 5q22)

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10
Q

osteoid osteoma on bone scintigraphy

A

hot, double density sign

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11
Q

median age osteoblastoma, M:F ratio

A

18 yo, 2-3:1 M:F

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12
Q

most common location of osteoblastoma in spine

A

posterior elements (>60%)

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13
Q

normal thickness plantar fascia

A

<3 mm

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14
Q

rugger jersey spine is seen in…

A

renal osteodystrophy

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15
Q

rhizomelia means…

A

shortening of proximal appendicular skeleton

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16
Q

hand site predilection for OA & erosive OA

A
  • PIP

- DIP

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17
Q

hand site predilection for psoriatic arthritis

A
  • DIP
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18
Q

hand site predilection for RA

A
  • MCP

- PIP

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19
Q

hand site predilection for gout

A
  • MCP
  • DIP
  • PIP
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20
Q

hand site predilection for CPPD

A
  • MCP
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21
Q

hand site predilection for scleroderma

A
  • DIP
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22
Q

most common bone dysplasia

A

achondroplasia

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23
Q

inheritance pattern multiple hereditary exostoses

chance of malignant degeneration

A

autosomal dominant

1-10%

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24
Q

bone scan and xray of pagets

A

lytic phase: bone scan hot, xray negative

mixed: both positive
sclerotic: bone scan less, xray findings

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25
Q

suprascapular vs spinoglenoid notch denervation

A

suprascapular - supra & infraspinatus

spinoglenoid - infraspinatus

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26
Q

causes SLAC

A
  • trauma
  • RA
  • CPPD
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27
Q

seronegative spondyloarthropathies

A

PAIR

  • psoriatic
  • ank spon
  • IBD associated arthritis (enteropathic)
  • reactive
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28
Q

gout mimickers

A
  • sarcoid
  • amyloid (chronic dialysis)
  • psoriatic arthritis
  • cystic RA
  • hyperlipidosis
  • multicentric histiocytosis
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29
Q

origin AIIS

A

rectus femoris

inserts on patella

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30
Q

dorsal intercalated segment instability (DISI)

A
  • dorsal tilt of lunate
  • scapholunate angle >60deg (sign of scapholunate lig dissociation)
  • capitolunate angle >30deg
  • after radial sided injury (scapholunate side); assoc with SL lig injury
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31
Q

volar intercalated segmental instability (VISI)

A
  • volar tilt of lunate
  • scapholunate angle <30deg
  • capitolunate angle >30deg
  • after ulnar sided injury (lunotriquetral side); assoc with LT lig injury
  • RA may result in any deformity, but esp ulnar translocation & VISI
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32
Q

capitolunate angle

A
  • angle btwn long axis of capitate & mid axis of lunate
  • N <30deg
  • increased (capitate displaced posteriorly compared to distal radius) in both DISI and VISI (scapholunate angle used to differentiate btwn the two)
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33
Q

scapholunate angle

A
  • angle btwn long axis of scaphoid & mid axis of lunate
  • N 30-60deg
  • increased in scapholunate dissociation
  • increased in DISI (w increased capitolunate angle)
  • decreased in VISI (w increased capitolunate angle)
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34
Q

SLAC wrist (scaphoid lunate advanced collapse)

A

progressive carpal collapse
1st radioscaphoid jt space narrowing, then arthrosis in triscaphe, capitolunate, & scaphocapitate jts

  • d/t trauma & lig laxity: + scapholunate diastasis; radiolunate jt usu not involved
  • d/t CPPD: both radioscaphoid & radiolunate jts
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35
Q

SNAC wrist (scaphoid non-union advanced collapse)

A
  • progressive carpal collapse w scaphoid # nonunion
  • 1st radial styloid beaking, then arthrosis in distal radioscaphoid jt, midcarpal jts
  • minimal arthrosis of proximal scaphoid pole fragment-radius, radiolunate articulations
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36
Q

greater trochanter facets

A
  • anterior: glut minimus
  • posterior: no attachment, GT bursa
  • lateral: glut medius
  • superoposterior: glut medius
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37
Q

magic angle effect

A

55deg from B0, the angle at which tightly bound collagen appear hyperintense if TE is short (PD or T1W)

  • mistaken for tendinopathy
  • disappears on T2 or if 55deg angle is changed
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38
Q

osteoblastoma: comparison to osteoid osteoma

A
  • larger >2cm
  • more aggressive; unlim growth potential, malig transformation reported
  • symptoms milder & more variable (even though more aggressive)
  • more common in vertebra, flat bones
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39
Q

Sinding-Larsen-Johansson syndrome

A

osteochondrosis of inf pole of patella
- at insertion of prox patellar tendon
chronic traction injury of the immature osteotendinous junction
active adolescents 10-14 yo, related to Osgood-Schlatter

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40
Q

Sprengel deformity

A

congenital elevation of the scapula

cosmetic & functional (restricted motion of scapula & glenohumeral jt)

associated w:

  • omovertebral bar (fibrous, cartilaginous or osseous connection btwn scapula & cspine)
  • Klippel-Feil
  • spina bifida
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41
Q

H-shaped vertebra seen in…

A

sickle cell disease
Gaucher disease

aka Lincoln log vertebra

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42
Q

anatomic landmark for glenohumeral anterior-inferior approach injection

A

junction of

  • physeal scar in humeral head
  • humeral head & glenoid overlap (crescent)
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43
Q

secondary signs ACL injury

A
  • deep sulcus (>2 mm)
  • bone contusions (lateral femoral condyle and posterolateral tibial plateau)
  • segond #
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44
Q

dorsal defect of the patella

A

round lucency in superolateral patella

normal variant, do not touch

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45
Q

location of liposclerosing myxofibrous tumor

A

intertrochanteric region of femur

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46
Q

Essex Lopresti fracture-dislocation

A

radial head #
DRUJ dislocation
(rupture of antebrachial interosseous membrane)

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47
Q

Tillaux fracture

A

Salter-Harris III # in older children
anterolateral aspect of distal tibial epiphysis
(medial aspect started to fuse)

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48
Q

fibrolipomatous hamartoma of the nerve

A

benign neoplasm of nerves, anomalous growth of fibroadipose tissue of nerve sheath
median (80%), ulnar, radial nerves

axial: coaxial cable-like appearance
coronal: spaghetti-like appearance

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49
Q

little leaguer shoulder

A

Salter Harris I # of proximal humerus

  • widening of the proximal humeral physis
  • sclerosis +/- fragmentation of adjacent bone
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50
Q

Malgaigne fracture

A

unstable pelvic # involving 1 hemipelvis, from vertical shear energy vectors
comprises of 2 ipsilat vertically oriented pelvic ring #s:
- anterior to acetabulum
- posterior to acetabulum
MC: ipsilat sup & inf pubic rami + SIJ (variants: ilium or sacral wing instead of SIJ)
- results in unstable lateral fragment, containing acetabulum

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51
Q

rotator cuff interval - contents

A

i) superior glenohumeral ligament (SGHL)
ii) long head of biceps tendon (LHBT)
iii) coracohumeral ligament (CHL)

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52
Q

rotator cuff interval - boundaries

A

anterior: posterior aspect of subscapularis tendon
posterior: anterior border of supraspinatus tendon
medial: lateral margin of base of coracoid process
roof: rotator interval capsule, reinforced by CHL

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53
Q

T sign (elbow)

A

interposition of joint fluid btwn ulnar collateral ligament (UCL) and sublime tubercle of ulna
- partial undersurface tear of the distal anterior bundle of UCL d/t recurrent trauma

54
Q

Bennett vs Rolando fractures

A

Bennett: 2-part intra-articular fracture of 1st metacarpal base
Rolando: 3-part or comminuted intra-articular fracture-dislocation of 1st metacarpal base

Bennett “Bad”, Rolando “Really bad”

55
Q

Panner disease

A

osteochondrosis of the capitellum
5-10 yrs; also in throwers
- no intra-articular loose bodies (cf. osteochondritis dissecans of the elbow which also affects capitellum)

56
Q

clay-shoveler fracture

A

avulsion fracture of spinous process of a lower cervical vertebra, usually C7

57
Q

radiographic features of osteomalacia

A

demineralization: smudgy/fuzzy, “erased”
coarsened trabecular pattern
pseudofractures/Looser zones (bone scan more sensitive)

58
Q

distal femoral metaphyseal irregularity (cortical desmoid)

A
  • saucer-shaped radiolucent cortical irregularity
  • posteromedial aspect of distal femoral metaphysis at attachment of adductor magnus tendon
  • do not touch lesion
  • adolescents (10-15 years of age)
59
Q

most important capsular ligament for glenohumeral stability

A

inferior glenohumeral ligament

IGHL also attaches to the anteroinferior labrum, which can avulse during shoulder dislocations

60
Q

resorption of distal clavicle

A 
"SHIRT"
scleroderma 
hyperparathyroidism
infection (osteomyelitis)
rheumatoid arthritis
trauma
61
Q

dermatofibrosarcoma protuberans (DFSP)

A

low grade malignant spindle cell tumor
surface tumor: arises in dermis, spreads to subQ tissue & muscles, often exophytic
MC on trunk > extremities
excellent prognosis after complete excision, but tend to recur locally
DDx: sebaceous cyst, epidermal inclusion cyst

62
Q

extensor compartments of wrist

A

“e” = “extensor” in front of each except APL

1: abductor pollicis longus (APL), e pollicis brevis (EPB); both affected in deQuervain’s
2: e carpi radialis longus, e carpi radialis brevis, Lister’s tubercle
3: e pollicis longus (EPL); delayed rupture after nondisplaced radial #
4: e digitorum, e indicis
5: e digiti minimi
6: e carpi ulnaris (ECU); tenosynovitis in RA

63
Q

quadriceps tendon rupture - predisposing factors

A

connective tissue disease (SLE, RA)
renal osteodystrophy
steroid use

64
Q

Madelung deformity

A 
short bowed distal radius 
volar subluxation of hand wrt ulna
V-shaped prox carpal row
exaggerated radial inclination
MRI: thick volar Vickers ligament
  • d/t premature closure or defective devel’t of medial dist radial epiphysis
  • rare congenital (manifests at 10-14 yrs) or acquired (growth plate trauma)
  • bilat: 50-66%
65
Q

trough line sign

A
  • represents reverse Hill Sachs of anteromedial humeral head on AP shoulder XR
  • from posterior shoulder dislocation
  • appearance: 2 nearly parallel lines in superomedial aspect of humeral head
66
Q

MSK manifestations of NF1 (non-spine)

A
  • multiple NOFs
  • ribs: ribbon deformity, notching, dysplasia
  • other dysplasias: esp tibia
  • tibial or ulnar pseudoarthrosis
  • thin/absent fibula
  • deficient bone form’n: thin cortex, erosive defects, sclerosis, periosteal prolif
  • limb hemihypertrophy
  • bowing: lat & ant
  • lambdoid suture defect
67
Q

MSK manifestations of NF1 (spine)

A
  • kyphoscoliosis
  • scalloped VBs
  • intrathoracic meningocele
  • neurofibromas, enlarged neural foramina
  • dural ectasia
  • hypoplastic posterior elements: thinning of pedicles, transverse processes, lamina
  • transverse process spindling: (50% loss of height of TP measured halfway btwn lateral edge of VB & tip of TP)
68
Q

Mazabraud syndrome

A

single or multiple intramuscular myxomas with fibrous dysplasia

69
Q

contents of quadrilateral space

A

axillary nerve

posterior circumflex humeral artery & vein

70
Q

borders of quadrilateral space

A

medial: lateral border of long head of triceps brachii
lateral: medial cortex of surgical neck of humerus
superior: teres minor m.
inferior: teres major m.
anterior: subscapularis m.
posterior: teres minor m.

71
Q

acromion types

A

Type I: flat undersurface
Type II: concave undersurface parallel to humeral head
Type III: inferior hook anteriorly

72
Q

Rockwood classification of acromioclavicular joint injury

A

I: mild sprain of AC lig
II: clavicle elevated but not above sup border of acromion
III: clavicle elevated above sup border of acromion but coracoclavicular dist <25 mm
IV: clavicle displaced post into trapezius
V: clavicle is markedly elevated, coracoclavicular dist >25 mm
VI: clavicle inf displaced behind coracobrachialis & biceps tendons (rare)

73
Q

subscapularis recess vs subcoracoid bursa

A

subscapularis recess

  • intra-articular
  • above superior margin of subscapularis
  • arthrogram: contrast pools under coracoid process ie in joint

subcoracoid bursa

  • extra-articular
  • anterior to subscapularis, inferior to coracoid process
  • arthrogram: contrast collects at needle
74
Q

sublabral sulcus criteria (distinguishing from SLAP tear)

A
  • follows curve of glenoid
  • uniform thickness
  • thickness up to 2mm
  • does not extend posterior to where biceps attaches to labrum
75
Q

tendons affected in de Quervain’s

A

abductor pollicis longus (APL)

extensor pollicis brevis (EPB)

76
Q

carpal tunnel contents

A

median nerve
1 flexor pollicis longus (FPL) tendon
4 flexor digitorum superficialis (FDS) tendons
4 flexor digitorum profundus (FDP) tendons
- middle & ring finger more superficial to index & little finger
NOT in tunnel: flexor carpi radialis (FCR), flexor pollicis brevis (intrisinc hand muscle), palmaris longus

77
Q

risk factors for soft tissue sarcomas

A 
(most de novo)
chemical carcinogens
prior radiation
viral infxn or immunodeficiency
genetic susceptibility: Li-Fraumeni, NF1
78
Q

dedifferentiated liposarcoma def’n

A

an atypical lipomatous tumour showing progression, primary or recurrent sarcoma of variable histological grade
- amplification of MDM2 (most cases)

79
Q

T2 target sign

A

neurofibroma
T2 hypointense centrally: nerve fiber
T2 hyperintense rim: myxoid content

80
Q

Mirels score

A

pathologic fracture prediction
1-3 points for 4 features (max 12):
- site, size, appearance, pain level
score of 9 = 33% chance of fracture after XRT

81
Q

Felty syndrome

A

rheumatoid arthritis
splenomegaly
leukopenia

82
Q

hemophilia in knee - findings

A

squaring of inferior pole of patella

widening of intercondylar notch

83
Q

hemophilia of ankle - finding

A

medial talar tilt

84
Q

WHO classification of liposarcoma

A
  1. well differentiated
  2. dedifferentiated
  3. myxoid (extrapulm mets)
  4. pleomorphic
85
Q

2 most common benign hand tumors

A
  1. ganglion

2. GCT of tendon sheath

86
Q

hemophilia xray findings

A 
Squaring inferior pole of patella
Widening of the interchondylar notch
Medial talar tilt
Periarticular osteoporosis
Gracile bones
Epiphyseal enlargement
Dense effusion (hemarthrosis)
87
Q

rhabdomyosarcoma subtypes

A
  1. embryonal (most common, esp in head & neck)
  2. botryoid
  3. alveolar
  4. pleomorphic
88
Q

high risk stress fractures

A
  1. lateral femoral neck
  2. anterior tibial shaft
  3. tarsal navicular
  4. fifth metatarsal
89
Q

ways to reduce metal artifact on MRI

A
  • ↓ magnetic field strength (1.5T)
  • ↑ bandwidth during slice selection
  • STIR for fat suppression (spectral frequency selective fat suppression performs better in a homogeneous field)
  • spin echo instead of gradient echo
  • ↑ matrix: 512 pixel
  • maintain good SNR by ↑ number of excitations (NEX)
  • shorter echo spacing
  • thinner slices
  • view-angle-tilting (VAT)
90
Q

calcaneal tuberosity avulsion association

A

diabetes

91
Q

achilles tendon rupture association

A

fluoroquinolones

92
Q

chordoma location by frequency

A

sacrum
clivus
vertebral body (MC C2)

93
Q

epiphyses equivalents

A 
carpals
patella
calcaneus
all apophyses:
- greater trochanter
- lesser trochanter
- iliac crest
- tuberosities
94
Q

Marrow reconversion appearance

A
  • Diametaphysis with sparing of epiphysis
  • symmetric and bilât
  • less C+
  • brighter than muscle on T1
  • bright on T2 fat sat
95
Q

Which joint spaces communicate?

  1. Glenohumeral joint and subacromial bursa
  2. Ankle joint and common peroneal tendon sheath
  3. Achilles’ tendon and posterior subtalar joint
  4. Pisiform recess and radiocarpal joint
A
  1. No - means full thickness rotator tear
  2. No - calcaneofibular lig tear
  3. No - Achilles not true tendon sheath
  4. Yes - normal
96
Q

Tendon classically injured in lateral epicondylitis

A

Extensor carpi radialis brevis

Lateral epicondylitis more common than medial

97
Q

Most common rotator cuff to tear?

Least?

A

Supraspinatus - 1-2 cm from footplate (avascular critical zone). HADD most common here

Least = teres minor

98
Q

Markers elevated in pagets

A

Lytic phase - none
Mixed phase - elevated alkaline phosphate
Sclerotic - elevated hydroxyproline

99
Q

Myxoid liposarcoma

A

<20 yo
T2 bright
T1 dark (confusing)

Need gad+
Not a cyst

100
Q

Signal characteristics amyloid

A

Low T1

Low T2

101
Q

Rhizomelic and mesomelic dwarfism types and example

A

Rhizo - Proximal long bones (humerus, femur) - (achondroplasia, achondrogenesis)

Mezo - Distal long bones (forearm and tib fib) - (rare - mesomelia synostosis syndrome)

102
Q

Second most common primary malignant bone tumor

A

Osteosarcoma

103
Q

nerve to make ‘ok’/pinch thumb & index

A

AIN

anterior interosseous nerve

104
Q

nerve injured in galeazzi #

A

anterior interosseous nerve

105
Q

nerve injured in monteggia #

A

posterior interosseous nerve

106
Q

high malignant transformation rate in exostoses

A

mafucci syndrome (up to 20%)

107
Q

anterior shoulder dislocation associated with?

A

bankart
hill sachs
greater tuberosity # in >50 yo

108
Q

tx glomus tumor

A

surgical resection

109
Q

ollier disease

A
  • predom unilat or asymmetric
  • metaphyses long bones
  • skull & spine are spared
  • stabilize/regress after skeletal maturity
  • ^ risk sarcoma degen
110
Q

multiple hereditary exostoses

A
  • auto dom
  • symmetric widening metaphyses
  • multiple osteochondromas
111
Q

gardner’s disease skeletal manifestation

A

osteomas

112
Q

1 location osteoid osteoma

A 
#1 femur
#2 tibia
113
Q

LCH most common locations

A 
#1 bone
#2 skin
majority 1-10 year olds
114
Q

most common locations of osteomyelitis in the diabetic foot

A

1st & 5th MT heads
phalanges
calcaneus

115
Q

intramuscular hemangioma

A
  • phleboliths
  • C+
  • T2 bright
116
Q

1 location nodular fasciitis

A

upper extremity

117
Q

adamantinoma

A
  • expansile
  • narrow zone transition
    +/- cortical breakthrough w/ soft tissue
118
Q

Gorham disease

A
  • disappearing bone (usually one)
    splenic cysts
    soft tissue changes
119
Q

nec fasc causes

A

85% polymicrobial

15% monomicrobial (10% of this GAS)

120
Q

gangrene

A

look for devitalized tissue that doesn’t enhance

121
Q

fascicular sign, split fat sign, eccentric to nerve

A

fascicular - both (schwann/NF)
split fat - both
eccentric to nerve - schwann

122
Q

osteopetrosis

A

impaired osteoclast dysfunction

123
Q

1 location malorrheostosis

A

lower extremity

124
Q

meniscal ossicle #1 location

A

posterior horn medial meniscus

125
Q

plantaris muscle % population

A

90%

126
Q

1 accessory muscle

A

peroneus quartus

127
Q

scheuermann disease

A

^ AP diameter
ant wedging ≥5 deg
3+ vert bodies
schmorl’s nodes

128
Q

shoulder, hip, wrist injection volumes

A

shoulder/hip - 10 cc

wrist - 3-5 cc

129
Q

ct arthro contrast:saline/anesthesia

A

1:1

130
Q

mr arthro gado:iodinated C+/saline/anesthetic

A

0.1-0.2 mL gado: 20mL rest

1/100-1/200

RRC Cards (17 decks)

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