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MSK Radiology > MSK - Odds & Ends > Flashcards

MSK - Odds & Ends Flashcards

1
Q

Most important predisposing factors to patellar instability (3)

A

1) Femoral trochlear dysplasia
2) Patella alta
3) Lateralization of the tibial tuberosity

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2
Q

Which measurements can be used to measure femoral trochlear dysplasia?

A

1) Lateral trochlear inclination (<11 degrees)
2) Trochlear facet asymmetry (<40 percent)
3) Trochlear depth (<3 mm)

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3
Q

Normal signal intensity of red marrow on T1WI

A

40% fat in red marrow - appears slightly hyperintense compared to skeletal muscle and intervertebral discs.
May see mild enhancement post-contrast.
Pathologic processes replace normal fatty marrow with water (so appear bright on fluid sensitive sequences).

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4
Q

Describe the typical sequence of marrow conversion

A

Starts in epiphysis, then moves to diaphysis and progresses bidirectionally but faster distally so only remaining red marrow is in the proximal femurs, humeri and axial skeleton

Yellow to red conversion occurs in opposite direction.

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5
Q

Causes of red marrow hyperplasia

A

Hypoxemic states (impaired delivery, increased demand)

  • anemia, sickle cell, thalessemia
  • smoking
  • cyanotic heart disease
  • athletes
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6
Q

What is the flip-flop sign? and what condition is this commonly seen in

A

Diffuse, heterogenous replacement of normal fatty marrow so appears dark on T1 and bright on fluid-sensitive sequences.
- Seen in ALL

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7
Q

CRMO - common sites, findings on MRI, ddx

A

Sites: medial clavicle, metaphyses of long bones, spine, pelvis
MRI: active areas are T2 hyper and enhance, quiescent are dark on T1 and T2 (variable appearance on x-ray)
DDx: other multifocal processes - acute bacterial osteomyelitis, LCH, mets, primaries- Ewings, Lymphoma, Leukemia

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8
Q

FIndings in Erdheim Chester-Disease

A

Multi-systemic histiocytosis (non langerhans cell)
Bone pain most common presenting sx
Bilateral, symmetric metaphyseal and diaphyseal sclerosis, cortical thickening, increased uptake on bone scan
Hairy kidney sign (soft tissue infiltration in pararenal space)
Soft tissue encasing aorta - IVC and ureters spared
Findings of LCH in the lung

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9
Q

DDx. for bone infarcts

A 
PLASTIC RAGS
Pregnancy
Lupus
Alcohol
Steroids
Trauma
Idiopathic, infection
Collagen vascular disease
Radiation
Amyloid
Gauchers
Sickle Cell
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10
Q

DDx. Erlenmeyer flask deformity (undertubulation)

A 
CHONG
Craniometaphyseal dysplasia 
Hemoglobinopathy (thalassemia, sickle cell) 
Osteopetrosis, osteochondromatosis/HME
Niemann-Pick disease
Gauchers
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11
Q

DDx Diffuse Sclerosis

A 
3 M'S PROOF
Myelofibrosis
Mastocytosis
Malignancy (diffuse blastic mets)
Sickle cell
Paget's 
Renal osteodystrophy
Osteopetrosis 
Other: osteopoikilosis, osteopathia striata, hyperthyroidism, normal variant (athletes)
Fluorosis
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12
Q

Ddx Ivory vertebra

A 
Osteoblastic mets (adult - prostate, breast, child - medulloblastoma, neuroblastoma)
Paget's 
Lymphoma
Chronic infection***
Hemangioma 
Children: add osteoblastoma
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13
Q

DDx expansile or lytic rib lesion

A

“FAME-B”

  • Fibrous dysplasia
  • ABC
  • Mets/MM/Plasmacytoma
  • Enchondroma
  • Brown tumour
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14
Q

Most common cause of acquired flat foot

A

Posterior tibial tendon tear

Spring ligament also maintains arch of foot

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15
Q

Signs of talocalcaneal coalition & calcaneonavicular coaltion

A
  1. C sign, talar beak

2. Anteater sign

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16
Q

Haglund syndrome findings

A
  1. Insertional achilles tendinopathy
  2. Retrocalcaneal bursitis
  3. Haglund deformity
17
Q

What structures make up the posterolateral corner?

A

LCL complex (LCL, biceps femoris, IT band)
Popliteus muscle
Popliteal fibular ligament
Arcuate ligament

18
Q

What structures make up the rotator interval?

A

CHL, LHBT, SGHL (located between the supraspinatus and the subscapularis)

19
Q

What structures make up biceps pulley?

A

CHL + SGHL + distal fibres of subscapularis

NB: CHL is the roof of the rotator interval, SGHL is the floor, biceps runs in the middle

20
Q

Most important component of capsulolabral complex for stability during abduction/rotation

A

IGHL

21
Q

What does TUBS stand for?

A

Traumatic, unidirectional, Bankart, surgical - a type of traumatic instability

22
Q

What does AIOS stand for? AMBRI?

A

Acquired, instability, overstress, surgery - athletes, repetitive movements, microinstability

Atraumatic, multi-directional, bilateral, rehabilitation, inferior capsule shift - usu due to congenital joint laxity

23
Q

Quadrilateral space margins?
Which structures travel through this?
What are imaging findings of syndrome?

A 
Borders: HTTT
Lateral humerus
Medial long head of triceps
Superior teres minor
Inferior teres major

structures:
- axillary nerve
- posterior humeral circumflex artery

Imaging findings: isolated teres minor +/- deltoid atrophy

24
Q

Imaging findings suprascapular nerve entrapment?

A

Atrophy of supra and infraspinatus muscles (often from paralabral cyst impinging on superior suprascapular nerve)

At the level of the spinoglenoid notch - will cause isolated atrophy of infraspinatus

25
Q

What is Parsonage-Turner?

A

Idiopathic brachial neuritis (viral versus inflammatory)
Almost always involves the suprascapular nerve (uncommonly axillary and subscapular nerve involvement) - supra, infra, deltoid
Imaging - edema –> fatty replacement

R/o other entrapment neuropathies (look for paralabral cyst, mass etc.)

26
Q

Most common type of carpal coalition

A

Lunotriquetral (#1)

Capitohamate (#2)

27
Q

DDx dense metaphyseal bands

A 
PRINCES
Poisoning (heavy metals)
Ricketts (healed)
INfection (TORCH)
Congenital (syphilis)
Endocrine (hypothyroid)
Scurvy, sickle cell
28
Q

DDx for acro-osteolysis

A

PINCH FO

  • psoriasis
  • injury (thermal or frost bite)
  • neuropathy (DM, leprosy)
  • collagen vascular (scleroderma, reynauds)
  • hyperPTH
  • familial - Hadju-Cheney
  • other - polyvinyl chloride
29
Q

Findings in idiopathic tumoral calcinosis

A

Hereditary disorder of phosphate metabolism, causing massive periarticular calcification
Involves large joints (hip, elbow, shoulder, feet, but usually not knees)
Cloud like calcification around the joint
No erosive changes in bone
DDx: other causes of periarticular calcification - CTDs, hyperparathyroidism, HO, synovial osteochondromatosis

30
Q

Ddx for diffuse periostitis

A 
HOA (**lung Ca + other causes)
Primary HOA (Pachydermoperiostitis) 
Vascular insufficiency
Multifocal nodular periostitis (chronic voriconazole use)
Thyroid acropachy (hands and feet)
31
Q

Neuropathic joint findings

A

5 D’s = disorganization, debris, density, dislocation and joint distension (atrophic form: shoulder, knee, hip; well demarcated area of osseous resorption)

32
Q

Causes of neuropathic joint

A

Central (i.e. shoulder) - Spinal cord tumour, syrinx, spina bifida, neurosyphilis (tabes dorsalis)
Peripheral (i.e. foot) - Diabetes**, nerve injury, leprosy, collagen vascular diseases

33
Q

List the complications after arthroplasty

A

1) Aseptic loosening (most common reason for revision)
2) Infection
3) Particle disease (giant granulomatous reaction to cement particles, marked osteolysis)
4) Fracture
5) Dislocation
6) Malpositioning (creep - normal - central, polyethylene wear - eccentric)
7) Metal-on-metal (pseudotumour, ALVAL - this is on a spectrum with particle disease, more likely to have large fluid collection around joint)

34
Q

What is FOP?

A

Fibrodysplasia ossificans progressiva (Munchmeyers disease) - MUMMY SYNDROME
- progressive fibrosis and ossification of muscles, tendons, fascia, ligaments starting in childhood

35
Q

Location of peroneus quartus

A

Posterolateral ankle, adjacent to peroneus brevis and longus; frequently bilateral

36
Q

Most common location meniscal ossicle

A

Posterior horn medial meniscus

Associated with posterior root tear

MSK Radiology (7 decks)

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