MSK-OPe, OP, OCD/OCL, RSD, osteochondroses Flashcards
osteopenia-definition, mcc
- bone lucency.
- OP=mcc
looser zones-what, where, appearance, mcc’s, type of fracture
also known as cortical infractions, Milkman lines or pseudofractures, are wide, transverse lucencies with sclerotic borders traversing partway through a bone, usually perpendicular to the involved cortex, and are associated most frequently with osteomalacia and rickets.
- type of insufficiency fracture
- wide Lucent bands traversing at right angles to cortex
- MC=femoral neck, pubic rami
- img: sclerosis surrounding lucency
- MCC=OM, Rickets; OI (less common)
osteoporosis-what, causes, appearance, complications
- low bone density (peaks at 30 yo)
- age (faster in menopause), mx (steroids, heparin, dilantin), endocrine (Cushings, HyperPTH), anorexia, OI
- compl: fractures (spine –> hip –> wrist)
order of osteoporotic involved fractures
spine –> hip –> wrist
DEXA-T and Z score
Measure of bone mineral density.
- Z score density relative to age-matched control
- T score= density relative to young adult. Defines Ope, OP
Significance of Dexa T score: T > -1, -1–>-2.5, <2.5
> 1= N
- 1–>-2.5 = Ope
- <2.5=OP
DEXA FPs & FNs
- FP: absent normal structures (ex: s/p laminectomy)
- FN: excessive osteophytes, dermal calcification, metal; too much femoral shaft , compression fx
FRAX
Fracture Risk Assessment Tool-predict fractures by RFs +/- femoral neck bone density
- 10 yr fracture risk
- who would benefit from pharmacologic intervention:
- hip fracture risk >3%
- major fracture risk >20%
- M & F
- recommended for T score -1 –> -2.5
Reflex Sympathetic Dystrophy (RSD)/Complex Regional Pain Syndrome/Sudeck Atrophy-what, mc locs, app (Rgx, bone scan)
- minor trauma, infection –> SNS overflow –> persistent pain, tenderness & swelling
- MC=hand, shoulder
- app:
- rgx: severe OPe. UL RA w/ preserved joint spaces
- 3phase hot bone scan - juxta/?intra-articular uptake 2/2 increased vascularity of synovial membrane
- delayed always hot
Transient osteoporosis
1) transient OP of hip
2) regional migratory OP
transient OP of hip-who, where, appearance, mx
- F, 3rd TM, left hip
- MC in men, BL
- app:
- Rgx: OPe
- MR: edema
- Bone scan: focal+
- joint space normal
- mx: self-limited ~ mo’s
regional migratory OP-what, who, app, mx
- idiopathic, M>F
- pain in joint –> resolving –> another joint
- self limited
transient osteoporosis vs AVN vs Fx
- TO=OPe–> Lucent
- TO vs AVN: both STIR+, T1-, joint effusion
- AVN serpiginous line
- Fx- line less serpiginous
osteoporotic compression fracture- MR app
T1 dark band like fracture line. T2 variable
neoplastic compression fracture-when, app, next step
- Entire VB replaced with tumor
- diffuse abN sign (not band-like) most prom pst
- next step: look at rest of spine
what does dark marrow represent? When is it bad?
- marrow infiltration
- red marrow
- bad = darker than adjacent (N) disc
osteochondritis dissecans/lesions (OCD/OCL)-what, why, where, complications, mx
- trauma, AVN –> aseptic sep osteochondral fragment –> fragmentation of articular surface, 2˚OA
- femoral condyle (MC), patella, talus, capitellum
- OA if unstable
Staging OCD/OCL
Stage 1-stable, covered by intact cartilage, con’t w/ host bone
Stage 2-stable on probing, partial discon’t w/ host bone
Stage 3-unstable on probing, complete discon’t
Stage 4-dislocated fragment
unstable OCD/OCL
high T2 signal undercutting fragment from bone
-edema=FP
capitellum lesions: OCD vs panner’s vs pseudo lesion
- OCD: 12-16 yo throwers. Ant convex margin. +/- loose bodies
- Panners: 5-10 yo throwers (Peter Pan). Entire capitellum. (-) LBs
- PL- Pst sloping looks like defect on coronal img
capitellum pseudo-lesion
pst capitellum looks like defect on coronal img due to abrupt slope
osteochondroses
group of osteonecrotic conditions involving epipyhysis/apophysis (usually childhood) with collapse, sclerosis, and fragmentation
Kohler’s osteochondrosis
- tarsal navicular
- Boys 4-6 yo
- mx-conservative
Freiberg infraction
- 2nd metatarsal head
- adolescent girls
- 2˚ OA
Sever’s osteochondrosis
- calcaneal apophysis
- “normal growing pain?”
Panner’s osteochondrosis
- capitellum
- 5-10 yo throwers
Perthes (LCP)
- femoral head
- 4-8 yo caucasian
Kienbock osteochondrosis
- carpal lunate; ass w/ negative unar variance
- 20-40 yo
Scheuermann osteochondrosis
- thoracic spine
- kyphosis > 40˚ + 3 adj VB wedging
what is normal AP kyphotic curvature of spine
-20-40˚
Sinding-Larsen-Johansson (SLJ)
inferior patella
-10-15 yo jumper
osgood-schlatter disease
- tibial tubercle
- 10-15 yo’s, jumper, kicker
- fragmentation + ST swelling
