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MSK CTC Flashcards

1
Q

what is involved in external snapping hip syndrome

A

IT band over greater troch

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2
Q

what is involved in internal snapping hip syndrome

A

iliopsoas over iliopectineal eminence

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3
Q

what is involved in intra-articular snapping hip

A

labral tear/joint body

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4
Q

what is the cross over sign in FAI

A

in pincer impingement (women) it refers to the anterior and posterior rims of the acetabulum forming a “figure of 8” sign on AP pelvis

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5
Q

what is a segond fracture and the mechanism of injury

A

fracture of the lateral tibial plateau, occurs with INTERNAL rotation and 75% have ACL tears

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6
Q

what is a reverse segond fracture and what is it associated with

A

fracture of the medial tibial plateau, assoc with PCL tear and medial mensicus tear

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7
Q

what is an arcuate sign and what injury is it associated with

A

avulsion of the proximal fibula at the insertion of the arcuate ligament complex, associated with PCL tear

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8
Q

what are the plain film findings of trauma related osteolysis

A

widening of physis (salter 1) in kids, most often in distal radius

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9
Q

what is seen in psoriatic arthritis not RA?

A

periostitis

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10
Q

what type of injury does mallet finger result from

A

forced hyperflexion hyperflexion-> avulsion of extensor tendon at dorsal DIP

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11
Q

what are the two most common fractures seen in newly weight bearing kids

A

1)toddlers fracture (spiral oblique or incomplete buckling of cortex), 2)stress fx of the cuboid

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12
Q

what is the arcuate sign on knee plain film

A

thin avulsion fragment at fibular styloid: represents avulsion of posterolateral corner structures

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13
Q

what is type 1 vs type 2 vs type 3 accessory navicular

A

type 1: small round ossicle, type 2: accessory forms flat facet with parent navicular, type 3: medially elongated extension of parent navicular

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14
Q

what is the pattern of maturation of bone in myositis ossificans

A

initially more mature bone peripherally than centrally

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15
Q

what fracture of the femoral head do u see with posterior hip dislocation

A

fracture of the anterior inferior femoral head

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16
Q

what is panners disease

A

OCD of the capitellum in kids/subchondral fracture of the capitellum

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17
Q

what are the findings of a lateral compression pelvic fx? is it stable or unstable?

A

horizontal pubic ramus fractures, sacral impaction fx, stable

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18
Q

what are the findings of a AP compression pelvic fx?

A

diastasis of the pubic symphysis and SI joints

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19
Q

on what view is a hill sachs imapction fx seen? on what view is reverse hill sachs fx seen? what is the trough sign?

A

internal rotation, see impaction fx at posterolateral humeral head (it hits the anteroinferior glenoid). reverse hill sachs is seen on axillary view. trough sign is impaction fx at humeral head with posterior dislocation, seen on AP view

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20
Q

what are the findings of turf toe

A

injury of the plantar plate of the first toe with proximal displacement of the sesamoids

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21
Q

what are the findings on xray of bisphosphonate related fx

A

subtrochanteric lateral cortical thickening in the hip and lateral beaking of the bone -> transverse pathologic fx

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22
Q

what is a snowboarders fracture in the ankle?

A

fx of the lateral process of the talus

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23
Q

what is the mgmt for garden 1 and 2 subcapital (nondisplaced) femoral fractures?

A

knowles pins. type 3 and 4 require hemi or total arhtroplasty

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24
Q

what is a maisonevve fracture?

A

fx of the medial malleolus or disrupted deltoid ligament, with extension of the force proximally, disruption of the syndesmosis, and fx of the high fibula

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25
Q

what are the MRI features of elastofibroma?

A

low T1 and T2 with some internal fat

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26
Q

what percent of elastofibromas are bilateral? what are the PET findings?

A

25% bilateral can be hot on PET

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27
Q

how does a bucket handle tear present clinically? what kind of meniscal tear is it?

A

p/w locking knee. it is a vertical tear, more common in medial meniscus, that propogates. see double PCL and blunted horns of the meniscus

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28
Q

how does the capitate move in a trans-scaphoid perilunate dislocation?

A

dorsally

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29
Q

what type of ulnar variance is kienbocks disease associated with? what population is it seen in?

A

ulnar minus, seen in men in their 20-40s that are manual laborers

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30
Q

which bone does sacroiliac septic joint usually affect?

A

erosions are seen more in the iliac bone

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31
Q

what are the complications of a galaeazzi fracture? which direction does the ulna dislocate?

A

non union of the distal radius fracture, entrapment of the extensor carpi ulnaris tendon. ulnar dislocates dorsally.

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32
Q

what is the most common and second most common types of tarsal coalition? what percent of coalition is bilateral?

A

calcaneonavicular, then talocalcaneal, 50% bilateral

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33
Q

what is the name for osteronecrosis of the scaphoid without trauma?

A

Preisers disease

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34
Q

which meniscus is discoid morphology more common in? what is diagnosed as a tear in a discoid meniscus?

A

lateral meniscus. if there is high signal in discoid meniscus, even w/o extension to articular surface, it is a tear.

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35
Q

what percent of legg calve perthes is bilateral? is it symmetric in the hips or asymmetric?

A

15%, commonly asymmetric

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36
Q

what is the pattern of involvement of bone in melarrhosterais?

A

involves one side of the bone and doesnt cross the articular surface. is also assoc with other dysplasias: osteopathica striata and osteopoliokosis

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37
Q

what is macrodystrophia lipomatosa?

A

enlargement of a single digit, usually 2nd or 3rd

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38
Q

what is an epidermal inclusion cyst in the finger?

A

lucent, unilocular lesion in the terminal phalanx that is due to old trauma, more common in men

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39
Q

what are the xray features of a glomus tumor in the finger?

A

very tender soft tissue lesion at the tuft, causes bony erosion near the nail bed

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40
Q

what arteries are commonly affected in an open book (AP compression) pelvic fx?

A

superior gluteal, internal pudendal

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41
Q

what is fong disease?

A

dysplasia of iliac horns, patellae, nails, autosomal dominant

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42
Q

what type of labral tear is associated with DDH?

A

anterosuperior aspect of the acetabulum

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43
Q

what is the only bone spared with multiple hereditary exostosis? what is the inheritance pattern?

A

the skull. autosomal dominnant.

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44
Q

what are the findings of atlantoaxial subluxation? what are the causes?

A

pre dental space more than 3 mm. causes are RA, trauma, CPPD, downs syndrome

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45
Q

what type of meniscal tear is commonly seen with bakers cysts?

A

tear of the posterior horn medial meniscus

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46
Q

what is calcific myonecrosis? where is it seen?

A

seen after trauma, plaque like calcifications, in the anterior compartment of the leg

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47
Q

what type of calcium is present in tumoral calcinosis?

A

calcium hydroxyapetite

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48
Q

what are the MRI features of giant cell tumor of a tendon sheath?

A

low T1, low T2 due to hemosiderin, blooming artifact on GRE

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49
Q

what type of tumor are most superior sulcus tumors?

A

adenocarcinoma

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50
Q

what is the best radiographic view to assess the SI joints?

A

ferguson view (30 degree cephalic tilt)

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51
Q

when does radiation induced sarcoma present?

A

10 years after radiation

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52
Q

what are the causes of iliopsoas bursitis?

A

RA, running

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53
Q

what are the findings of spondyloarthropathy of hemodialysis?

A

erosions at the endplates and calcs of the ligamentum flavum

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54
Q

what are the imaging diffs btw secondary and primary HPOA? what are the bone scan findings? what is the most common malignancy associated with secondary HPOA?

A

secondary spares the epiphysis. bone scan shows increased uptake along the cortices of the bones. associated with NSCLC in 90 percent of cases.

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55
Q

what are the findings of thyroid acropachy?

A

metatarsal and metacarpal periostitis

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56
Q

what is injured in gamekeepers thumb? what is a stener lesion? what has unopposed effect on it?

A

the UCL of the first MCP, stener lesion complete UCL avulsion that gets trapped by the adductor pollicis aponeurosis

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57
Q

where is a meniscal ossicle most commonly seen? what does it look like?

A

posterior horn of the medial meniscus. triangular opacity at medial meniscus.

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58
Q

what ulnar variance is associated with physiologic bowing of the radius and ulna?

A

ulnar negative

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59
Q

what view is a pseudolesion of the humeral head seen on?

A

internal rotation only

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60
Q

what are transverse growth lines?

A

thin TV lines seen due to increased osteoblatic activity after recent illness

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61
Q

where is a cortical desmoid seen? what inserts here?

A

posteromedial femur, at the origin of the medial head of the gastroc and the aponeurosis of the adductor magnus

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62
Q

what is medial epicondylitis?

A

tenditis of the common flexor tendon

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63
Q

what is the ulnar attachment of the ulnar collateral ligament?

A

sublime tubercle

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64
Q

what causes an avulsion fx of the medial epicondyle?

A

younger patients: excessive pull of the common flexor tendon, older patients: UCL avulsion

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65
Q

what are causes of madelung deformity?

A

turners, trauma, multiple hereditary exostosis

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66
Q

what are common causes of SLAC in the wrist?

A

trauma, CPPD

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67
Q

what is nail patella syndrome?

A

autosomal dominant, nail changes, ILIAC HORNS, and dysplastic radial head and capitellum at the elbow with a prominent medial epicondyle

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68
Q

what is the order of ossification of bones in fibrodysplasia ossificans progressiva? what is the inheritance?

A

SCM, shoulder, arms, spine and pelvis. autosomal dominant

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69
Q

what is macrodystrophia lipomatosa? what nerves does it most common affect in the hand and foot? what digits of the hand does it affect?

A

focal gigantism, nerve territory oriented macrodactyly, neural fibrolipoma. often affects the median nerve and plantar nerves in the feet. affects 2nd and 3rd digits in the hand.

70
Q

is tuft acro-osteolysis seen with primary or secondary HPOA? tuft hypertrophy?

A

lysis: primary, hypertrophy: secondary

71
Q

what is a schmorl node?

A

intra osseous disc herniation thru a weakend endplate

72
Q

what is sprengel deformity?

A

scapula connected to cervical spine by a fibrous band

73
Q

which type of OI is lethal at birth? which type causes probs throughout childhood into adulthood?

A

type 2 is lethal. type 3 causes multiple fractures and bowing deformities.

74
Q

what bones does melarhostosis spare?

A

the facial bones and skull

75
Q

is osteopetrosis due to abnl osteoblasts or osteoclasts?

A

osteoclasts

76
Q

what does a limbus vertebra look like?

A

triangular ossicle at the anterior superior VB

77
Q

what percent of DDH is bilateral? what is seen in the acetabular roofs in DDH?

A

20 % bilateral. upturning of the lateral acetabular roofs.

78
Q

how many images must the abnormality be seen on to diagnose discoid meniscus?

A

at least 3 slices on sagittal slices, 5 mm thick.

79
Q

what is the earliest radiographic sign of septic arthritis?

A

a joint effusion

80
Q

what are the most common organisms to cause nectrotizing fasciitis?

A

polymicrobial, step a

81
Q

if you biopsy myositis ossificans what diagnosis might you get?

A

sarcoma

82
Q

what part of the tibia and femur exhibit contusions after ACL tear?

A

posterolateral tibia, anterior lateral femoral condyle

83
Q

what is a pivot shift injury?

A

valgus load applied to knee while it is flexed

84
Q

what dorsal compartment of the wrist is the extensor carpi ulnaris in? what separates compartment 2 and 3?

A

compartment 6. the lister tubercle separates comp 2 and 3.

85
Q

what are the boundaries of the quadrilateral space?

A

superior: teres minor, inferior: teres major, lateral: humerus, medial: triceps

86
Q

what are the contents of the rotator interval?

A

long head of the biceps, subscap, superior GH ligament, coracohumeral ligament.

87
Q

what nerve does a paralabral cyst in the spinoglenoid notch compress? what muslces does this nerve innervate?

A

suprascapular nerve -> edema of the infrapsinatus.

88
Q

what part of the bone do osteochondromas most commonly arise from?

A

metaphysis

89
Q

what prevents proximal retraction of the tendon in a distal biceps tendon tear?

A

the lacertus fibrosis aka bicipital aponeurosis

90
Q

what attaches to the anteroinferior pubic symphysis? what pathology can be seen with a detachment here?

A

adductor muscles and recutus abdominis aponeurosis. detachment can lead to athletic pubalgia aka sports hernia

91
Q

what is the rim sign of posterior shoulder dislocation?

A

increased distance btw the glenoid and the humeral head on frontal view

92
Q

what is avulsed in a 5th metatarsal avulsion tuberosity fracture?

A

peroneus brevis and/or plantar aponeurosis

93
Q

what tendons are involved in de quervian tenosynovitis?

A

extensor tendons of compartment 1: abductor pollicis longus and extensor pollicis brevis (EPB, APL)

94
Q

what is a clay shoverlers fx? stable or unstable?

A

fx of the spinous process of C6, C7, or T1 due to hyperflexion. it is stable

95
Q

luxatio erecta can cause injury to what structures?

A

axiallry artery and vein, brachial plexus, rotator cuff

96
Q

what is a bennet fx in the hand? what causes unopposed proximal migration of the larger fx fragment?

A

non communited, intraarticular fx at the base of the thumb. unopposed action of abductor pollicis longus causes proximal migration

97
Q

what are the two portions of the coracoclavicular ligament?

A

trapezoid and conoid

98
Q

what type of stress causes gamekeepers thumb?

A

excessive valgus stress. it is an injury to the UCL at the base of the thumb (MCP joint). can get a stener lesion where the proximal torn UCL gets trapped superficial to the adductor aponeursis

99
Q

which meniscus does a bucket handle tear most commonly involve?

A

medial. in lateral bucket handle, u dont see the double PCL sign bc the ACL blocks the fragment from going into the intercondylar notch.

100
Q

what type of repetitive injury most commonly causes an OCD of the talar dome?

A

inversion injury

101
Q

what type of injury is a volar plate avulsion of the finger seen in? where is it most common?

A

hyperextension. PIP joint.

102
Q

what does the peroneal n arise from? how does it travel to the fibular head? where is it most prone to direct injury? what clinical symptom is seen with peroneal n injury?

A

arises from the sciatic n, courses posteriorly to the biceps femoris to the level of the fibular head and then laterally. most prone to injury at the fibular head. get foot drop/cant dorsiflex.

103
Q

what type of mechansim of injury causes a spiral fx of the distal fibula, a posterior mall fx, and a transverse fx of the medial mall?

A

supination external rotation

104
Q

what is a nightstick fx in the arm?

A

non displaced ulnar fx

105
Q

what injuries are assoc with a reverse segond fx?

A

PCl and medial meniscus

106
Q

which type of proximal femur fx is most susceptible to AVN? is this intracapsular or extracapsular?

A

subcapital. intracapsular (other IC fx are basivervical and transcervical)

107
Q

in what population is transient osteoporosis of the hip seen?

A

female in 3rd trimester of pregnancy, left hip

108
Q

what two spaces can be used for wrist arthropgraphy?

A

radiocarpal joint and pisiform recess

109
Q

in the hand when is tenosynovitis an emergency? what condition can this be seen in?

A

tenosynovitis of any flexor tendon is emergent. often seen with RA.

110
Q

what tendons in the hand does RA most commonly affect?

A

extensor carpi ulnaris (comp 6) and the flexor tendons.

111
Q

what does a fibroma in the finger look like?

A

dark T1 and T2 with no blooming on gradient

112
Q

what is tennis elbow? what kind of injury is it? what tendon does it affect?

A

lateral epicondylitis, varus stress, affects the common extensor tendon (often ex carpi radialis brevis)

113
Q

what is a HAGL lesion? what do u see on MR with contrast?

A

humeral avulsion of the glenohumeral ligament. it is an avulsion of the IGHL. you see a “j” shaped collection of contrast in the inferoglenohumeral recess (more contrast collects).

114
Q

what is a buford complex?

A

absence of the anterosuperior labrum

115
Q

what does a cyst in the suprascap notch cause? what does a cyst in the spinoglenoid notch cause? what nerve runs across?

A

atrophy of the supra and infraspinatus. spinoglenoid only causes infraspinatus atrophy. suprascapular nerve runs across.

116
Q

what muscle does quadrilateral space syndrome affect?

A

the teres minor

117
Q

what is the transverse ligament in the shoulder? what does subscapularis tendon tear cause?

A

fibers of the subscapularis that extend to the greater tuberosity, across the bicipital groove. subscap tears causes medial dislocation of the long head of the biceps tendon.

118
Q

what type of meniscal tear is commonly associated with a lateral meniscal cyst?

A

horizontal cleavage

119
Q

when u have a bucket handle tear and u see a double PCL sign, which ligament must be intact?

A

the ACL

120
Q

what is the master knot of henry in the medial ankle?

A

where the FDL crosses the FHL

121
Q

why do u get valgus deformity of the hindfoot in acute flat arch with PTT tear?

A

bc of unopposed action of peroneal brevis

122
Q

what type of injury is associated with split peroneus brevis?

A

inversion injury

123
Q

what is anterolateral impingement syndrome in the ankle?

A

injury to anterior talofibular and anterior tibiofibular ligaments causes lateral instability and synovial inflammation, see T1 and T2 dark mass in the lateral gutter

124
Q

where is the tarsal tunnel in the ankle?

A

behind the medial malleolus

125
Q

where do u see septic arthritis in IVDA?

A

SC joint and SI joint

126
Q

what is the first sign of a septic joint?

A

joint effusion

127
Q

in what conditions do u see rice bodies?

A

RA and TB

128
Q

where in the bone does parosteal osteosarc most commonly occur? periosteal osteosarc? what age groups are each seen in?

A

parosteal: metaphyseal, middle age. periosteal: diaphyseal, young teens.

129
Q

what are two common risk factors for chondrosarcoma?

A

osteochondroma and pagets.

130
Q

what genetic translocation is synovial sarcoma associated with?

A

X-18

131
Q

what are the three b9 epiphyseal bone lesions? what is an epiphyseal malignant tumor of the bone?

A

age less than 30: AIG: ABC, infection, giant cell, chondroblastoma. clear cell chondrosarcoma is epiphyseal and malignant.

132
Q

is fibrous dysplasia an abnormality of osteoblasts or osteoclasts?

A

osteoblasts

133
Q

what are the most common causes of vertebra plana?

A

MELT: Mets/myeloma, EG, lymphoma, trauma/TB

134
Q

what percent of giant cell tumors have pulmonary mets?

A

5%

135
Q

does multiple myeloma first cause a problem of sclerosis or lysis?

A

plasma cell proliferation cuases increasing osteolytic activity

136
Q

what is the ddx for a lucent lesion in the posterior elements?

A

osteoblastoma, ABC, TB

137
Q

where in the bone does chondroblastoma occur? what are the T1 and T2 features?

A

epiphysis. T1 and T2 DARK. not malignant but 30 percent recur

138
Q

what is the only b9 bone lesion assoc with radation? what is a common malignant lesion?

A

osteochondroma. sarcomas.

139
Q

what is an avian spur?

A

a supracondylar spur in the elbow that points TWD the joint (as opposed to osteochondroma), can smash median n if ligament of struthers is involved

140
Q

what is milwaukee shoulder?

A

destruction of the shoulder secondary to hydroxyapetite with intra-articular loose bodes.

141
Q

what part of the spine does DISH most commonly affect? OPPL?

A

DISH: thoracic spine. OPPL: C-spine, old asian men

142
Q

in what conditions do u see an enlarged epiphysis and wide intercondylar notch in the knee?

A

hemophilia and JRA

143
Q

what malignancy do osteochondromas potentially convert to? what percent convert in multiple hereditary exostoses?

A

chondrosarcoma, 1-3 percent degenerate

144
Q

what is the MR appearance of synovial chondromatosis? does it enhance? what are the nodular bodies made of?

A

low T1, high T2, the synovium enhances. made of hyaline cartilage.

145
Q

where in the bone does fibrous dysplasia normally occur?

A

diaphysis

146
Q

what type of cells are in solitary fibrous tumors? what is another name for solitary fibrous tumor? what do u see clinically/labs?

A

spindle cells. aka hemangiopericytoma. assoc with hypoglycema

147
Q

in what arthritis do u see ivory phalanx?

A

psoriatic arthritis (increased sclerosis of the big toe)

148
Q

in what age group and gender is erosive osteoarthritis most common?

A

post menopausal women

149
Q

what is jacoud arthritis?

A

arhtropathy that looks like lupus (reversing subluxations) post rheumatic fever, usually ulnar sided

150
Q

what does lupus arthritis look like?

A

deforming arthritis without erosions, symmetric, reducible subluxations

151
Q

where is an OCD in the elbow most likely seen? pseudodefect of the capitellum?

A

anterolateral cap, pseudodefect is seen posterolaterally.

152
Q

what is panners disease? what age group is it seen in?

A

AVN (osteochondrosis) of the capitellum, in a 5-10 yr old, self limiting, NO loose bodies

153
Q

what is the diff in appearance in primary synovial osteochondromatosis vs secondary?

A

loose bodies are SAME size in primary, diff sizes in secondary

154
Q

In diffuse pagets, what bone is most likely to be spared?

A

the fibula

155
Q

what cells are reacting in particle disease? what are the MRI features of lytic lesions in particle disease? is there periosteal reaction?

A

histiocytes. lytic lesions are lISO T1 and low T2. there is NO periosteal reaction

156
Q

what does “creep” mean in a hip arthroplasty?

A

penetration of the femoral head component into the acetabular cup in the direction of the spine

157
Q

what are the three main injuries seen in a “thrower” elbow? how is a UCL tear managed?

A

VALGUS stress causes ulnar coll lig tear, common flexor tendon tear, ulnar n injury. usually the flexors keep the function of the elbow normal even after the UCL tears.

158
Q

what b9 lesion can a ABC develop from? what is the most common location for an ABC

A

40% can arise from a giant cell tumor - if this is the case, it is a secondary ABC. most commonly seen at the metaphysis of the tibia

159
Q

what MRI sequence is the least sensitive for a meniscal tear?

A

T2 (long TE) is bad for a tear of the meniscus

160
Q

what are the three types of discoid meniscus? what type has no capsular attachment?

A

complete, incomplete, wrisberg. wrisberg has no capsular attachment.

161
Q

in acute ACL tear, is the medial or lateral meniscus more likely to be torn? what part? what type of meniscal tear is it?

A

posterior horn of the lateral meniscus. longitudinal tear.

162
Q

what are the two types of vertical meniscal tears?

A

longitudinal and radial

163
Q

what is the tendon that tears in an avulsion fx of the base of the 5th metatarsal?

A

peroneus brevis

164
Q

A posterior tibial tendon tear is most commonly seen with what accesory ossicle in the foot? A tear of the peroneaus brevis is most commonly associated with what accessory muscle?

A

PTT tear is associated with presence of acc navicular. per brevis tear is associated with presence of a peroneus quartus.

165
Q

what are the signs of adhesive capsulitis on MRI?

A

loss of fat in rotator cuff interval, decreased joint capacity (its stiff), thick IGHL in axillary pouch

166
Q

in a buford complex, at what slice do u see a thick MGHL on an axial view?

A

at the level of the biceps inserting into the bicipital groove

167
Q

where is arthritis first seen with SLAC and DISI? which way does the scaphoid like to migrate? lunate?

A

scapho-radial joint. scaphoid likes to go VOLAR, lunate likes to go DORSAL.

168
Q

what epicondyle and condyles are the most likely to be fx in an elbow?

A

mEdial Epicondyle and lateral condyle.

169
Q

what is anisotropy? where is it commonly seen? why does it occur?

A

hypoechoic artifact in an echoic tendon mimicking a tear. seen in supraspin and long head of biceps. caused by the sound beam being NOT perpendicular to the tendon.

170
Q

when does calcific myonecrosis occur? what is the mgmt?

A

decades after trauma. mgmt is non surgical

171
Q

what are the imaging features of tumoral calcinosis?

A

often bilateral, can see fluid layering level, periarticular, can be primary (herediatry) or secondary (aka metastatic calcification in ppl with renal failuer/dialysis)

172
Q

what are the imaging features of tumoral calcinosis?

A

often bilateral, can see fluid layering level, periarticular, can be primary (herediatry) or secondary (aka metastatic calcification in ppl with renal failure/dialysis)

MSK (2 decks)

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