MSK CORE 2 - Sheet1 Flashcards
2 fractures of the base of the first metacarpal?
Bennett and Rolando (comminuted)
gamekeeper’s thumb
avulsion fracture of the base of the proximal phalax (+ UCL disruption)
what ligament in disrupted with gamekeeper’s thumb?
ulnar collateral ligament
Stener lesion is associated with what named fracture?
gamekeeper’s thumb - the Adductor tendon gets caught in the torn edges of the UCL.
median nerve distribution
thumb to radial aspect of 4th digit
accessory muscle associated with cubital tunnel syndrome
anconeus epitrochlearis
the site where the ulnar nerve passes beneath the cubital tunnel retinaculum is aka
the epicondylo-olecranon ligament or Osborne band
Hill-Sachs is best seen on which view?
internal rotation view
which nerve is injured in 60% of inferior shoulder dislocations?
axillary
bisphosphate fracture is typically on which side of the femur?
lateral
stress fracture is typically on which side of femur?
medial
SONK is not actually osteonecrosis, but is
an insufficiency fracture that favors the medial femoral condyle of old ladies
what do Looser Zones look like?
wide lucent bands that transverse bone at right angles to the cortex
ligament torn in “Terry Thomas” sign?
scapholunate ligament
tendons involved in De Quervains tenosynovitis?
first dorsal (extensor) compartment (extensor pollicis brevis and abductor pollicis longus).
Dupuytren Contracture:
nodular mass on the palmar aspect of the aponeurosis that progresses to cord-like thickening and eventual contracture (usually involving the 4th finger).
T-sign (MRI elbow)
UCL partial tear
which elbow part is most commonly involved in Panner and OCD?
capitellum
Panner vs. OCD: age
Panner: 5-10 OCD: teenager
tendon/ligament involved with lateral epicondylitis (tennis)
Extensory tendon injury (classically extensor carpi radialis brevis) and Radial Collateral Ligament Complex - Tears due to varus stress
tendon/nerve involved in Medial Epicondylitis (golfers)
Common flexor tendon and ulnar nerve may enlarge from chronic injury
most common form of shoulder impingement
subacromial - attrition of coracoacromial arch
which tendon is damanged in subacromial impingement?
supraspinatus
mechanism of subcoracoid impingement?
lesser tuberosity and coracoid do the pinching
which tendon is damanged in subcoracoid impingement?
subscapularis
who gets posterior superior internal impingement?
Athletes who make overhead movements.Greater tuberosity and posterior inferior labrum do the pinching.
which tendon is damanged in posterior superior impingement?
lnfraspinatus (and posterior fibers of the supraspinatus).
SLAP acronym
“superior labral tear from anterior to posterior”
SLAP under 40yo
bankart lesion
SLAP over 40yo
rotator cuff tear
Spectrum of Bankart Lesions (least to most severe)
GLAD –> Perthes –> ALPSA –> True Bankart
definition: GLAD lesion
Glenolabral Articular Disruption. No instability (aren’t you GLAD there is no instability)
definition: Perthes
Detachment of the anteroir lnferior labrum (3-6 o’clock) with medially stripped but intact periosteum.
definition: ALPSA
Anterior Labral Periosteal Sleeve Avulsion. Medially displaced labroligamentous complex with absence of the labrum on the glenoid rim.
HAGL
humeral avulsion (of the inferior) glenohumeral ligament
spinoglenoid notch
infraspinatus atrophy
suprascapular notch
supraspinatus
quadrilateral space syndrome
axillary nerve - atrophy of teres minor
what if you see atrophy of muscles in 2+ nerve distributions?
parsonage-turner - idiopathic involvement of the brachial plexus
other injury commonly associated with subscapularis tear?
medial dislocation of the long head of the biceps tendon
“double PCL” can only occur in the setting of an intact…
ACL - bucket handle tear of usually the medial meniscus
meniscal ossicle
focal ossification of the posterior horn or the lateral meniscus,
O’Donoghue’s Unhappy Triad:
ACL Tear, MCL Tear, Medial Meniscal
When I say “kissing contusion”, you say
ACL tear
What’s the Master Knot of Henry?
It’s a “Harry Dick” (where Dick (FDL) crosses Harry (FHL) at the medial ankle)
I Say PTT (posterior tibial tendon) is out, You Say
Spring Ligament is Thickened, and Hindfoot Valgus
MRI finding in sinus tarsi syndrome
MRI finding is obliteration of fat in the sinus tarsi space and replacement with scar.
Tarsal Tunnel Syndrome:
Pain in the distribution of the tibial nerve (first 3 toes), from compression as it passes through the tarsal tunnel (behind the medial malleolus).
how do you maintain the ability to plantar flex in the setting of Achilles tendon rupture?
if your plantaris muscle is intact
plantar fasciitis is worse at what time of day?
morning
definition: sequestrum
a segment of necrotic bone that is separated from living bone by granulation tissue
definition: involucrum
a layer of living bone that has formed about dead bone; it can become perforated by tracts
definition: cloaca
An opening in the involucrum
osteomyelitis <1 month
multicentric involvement with joint involvement (bone scan often neg)
osteomyelitis <18 month
spread to epiphysis through blood
osteomyelitis 2-16 years
transphyseal vessels are closed (primary focus is metaphysis)
what primary bone tumor can cause occult pneumothorax
osteosarcoma met to the lung
most common primary malignancy of the sacrum?
chordoma
when involving the spine (instead of the sacrum), chordoma is most common at what level?
C2 (and very T2 bright!)
treatment for osteosarcoma
Chemo tirst (to kill micro mcts) , followed by wide excision
treatment for Ewings
Both Chemo and Radiation, followed by wide excision.
treatment for chondrosarcoma
usually just wide excision
treatment for giant cell tumor
Because it extends to the articular surface usually requires arthroplasty.
classic location of cortical desmoid
radiolucent cortical irregularity involving posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon
epiphyseal equivalents you should remember
carpals, patella, greater trochanter, calcaneous - epiphyseal lesions can happen here too
Shepard Crook deformity
fibrous dysplasia in the femur
Mazabraud = polyostotic fibrous dysplasia + what other soft tissue finding
soft tissue myxomas - also increased risk of osseous malignant transformation
McCune Albright
polyostotic fibrous dysplasia + girl + cafe au lait + precocious puberty
3 classic appearances of EG
- vertebra plana in a kid 2. skull with lucent “beveled edge” lesions 3. “floating tooth” with lytic lesion in alveolar ridge
what age gets EG?
less than 30
class ddx for vertebra plana (MELT)
mets/myeloma, EG, lymphoma, trauma/tb
most common age for giant cell tumor?
20-30 (physis must be closed)
Jaffe-Campanacci Syndrome:
Syndrome of multiple NOFs, cafe-au-lait spots, mental retardation, hypogonadism, and cardiac malformations.
‘Pain at night, relieved by aspirin. “
osteoid osteoma
osteoblastoma vs. osteoid osteoma
osteoblastoma = osteoid osteoma > 2cm, patients <30yo, posterior elements
3 classic blastic mets
prostate, carcinoid, medulloblastoma
2 classic lytic mets
renal and thyroid
uncommon/classic presentation of MM
diffuse osteopenia
classic ddx for lucent lesion in posterior elements (3)
osteoblastoma, ABC, TB
age for ABC
<30 yo
age for chondroblastoma
kids 2-25
3 classic lesions of the intertrochanteric region
lipoma, solitary bone cyts, monostotic fibrous dysplasia
classic location of liposclerosing myxofibroma
intertrochanteric region of the femur (geographic lytic lesion w/sclerotic margin)
what’s the other name for osteochondroma?
exostosis
what’s another name for Trevor disease?
(Dysplasia Epiphysealis Hemimelica - DEH): osteochondromas in the ankle/knee epiphyses with joint deformity in young kids
which way does avian spur point?
toward the joint (exostosis is away)
when I say avian spur, you say
ligament of struthers (smashes the median nerve if symptomatic)
when is tibial bowing normal?
18 months - 2 years
When I say Ankylosis in the Hand, You Say
Erosive OA or Psoriatic
Reiter’s is rare in the
hands (Just remember Reiters below the waist.)
ARRS Hooray!
Gout mimickers: Amyloid, RA, Reticular histiocytosis, Sarcoid, Hyperlipidemia
2 things that give you hooked MCP osteophytes
Hemochromatosis or CPPD (with chondrocalcinosis in the TFCC)
milwaukee shoulder
almost-neuropathic looking shoulder 2/2 hydroxyapatite
5 Classic ways of showing hyperparathyroidism (renal osteodystrophy)
- rib notching 2. resorption along radial aspect of fingers AND brown tumors 3. tuft resorption 4. rugger jersey spine 5. pelvis with “constricting” femoral necks + wide SI joints
cervical spine fusion (2)
Congenital (Klippel-Feil) or JIA
erosion of the dens (2)
CPPD or RA
bad kyphosis of the c-spine
NF1
big bridging lateral osteophytes (spine)
psoriatic arthritis
“flowing syndesmophytes”
ank spond
reversible ulnar deviation without erosions
SLE
non-erosive ulnar deviation s/p rheumatic fever
Jacoud’s arthropathy
ossification of the ALL with sparing of disc spaces
DISH (T-spine most common)
yellow marrow increases with
age
normal pattern of bone marrow conversion
The epiphyses convert to fatty marrow almost immediately after ossification. Distal then proceeds medial (diaphysis first, then metaphysis).
normal pattern of bone marrow reconversion?
reverse order of normal marrow conversion, beginning in the axial skeleton and heading peripheral.
What areas are spared/normal variants in bone marrow conversion?
proximal femoral metaphysis of teenagers.The distal femoral sparing is especially true in teenagers and menstruating women.
what does bone marrow look like in leukemia?
darker than muscle (and normal discs) on T1
most frequent tendon involved in hydroxyapatite deposition?
supraspinatus (near the greater tuberosity); also like to test longus coli
transmission method of osteopoikilosis
AD
Engelmann’s disease
progressive diaphyseal dysplasia - fusiform bony enlargement with sclerosis of the long bones (starts in kids)
“widening of the joint space in an adult hip”
Pituitary Gigantism
most common complication of Paget’s
deafness
abnormal lab in mixed phase of Paget’s
elevated alkaline phosphate
abnormal lab in sclerotic phase of Paget’s
elevated hydroxyproline
