MSK- part b Flashcards
What is Tendinopathy?
- bothtendon inflammation andsmall tears that sometimes develop intissue surrounding the tendon
- associate tendinopathy withdeterioration ofa tendon where it connects to the bone (entheses)
partial or complete tears are due to? (5)
Trauma Aging Calcification Cortisteroid therapy Systemic diseases
sono signs of tears?
- Partial or complete discontinuity of fibers
- Focal thinning tendon
- Hematoma
- Bone fragment
- Nonvisualization of retracted tendon (complete)
what is Tendinosis?
- degeneration of the tendon’s collagen in response to chronic overuse without signs of inflammation
- Patellar and Achilles tendon
- Nodular thickening of tendon
sono apperance of tendinosis?
- focal or diffuse areas of decreased echogenicity
- tendon enlargement
what is enthesopathy?
- pathologic change of the insertion of tendons, ligaments and joint capsules on the bone
- spondyloarthropathies (SpA), other rheumatic disease
sono apperance of enthesopathy?
- swollen, hypoechoic tendon insertion
- calcification – chronic
- bursitis
what is Tendinitis?
- where is it most common (4)
- inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone
- causes pain and tenderness just outside a joint
- most common around shoulders, elbows, wrists and heels
Some common names for various tendinitis problems are? (5)
Tennis elbow Golfer's elbow Pitcher's shoulder Swimmer's shoulder Jumper's knee
Sonographic Signs Tendinitis?
- Thickening of tendon
- Decreased echogenicity
- Blurred margins
- Increased color Doppler flow
- Calcifications – chronic
- Deformed margins - chronic
what is Tenosynovitis?
pain andinflammationin a tendon sheath
both the tendon and the sheath can become painful andinflamed
Sonographic Signs of Tenosynovitis?
- actue
- chronic
acute:
- fluid in sheath
- internal echoes from debris
chronic:
- hypoechoic thickening of sheath
- no fluid
what is bursitis?
inflammation of a bursa, a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body
what causes bursitis?
become inflamed from injury, infection, or due to an underlying rheumatic condition
s/s bursitis?
localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area
Sonographic Appearance of normal bursa?
thin hypoechoic line no more than 1–2mm in height with hyperechoic boundaries reflective of a fluid tissue interface
sono apperance of bursitis?
- acute
- chronic
acute: sonolucent fluid filled collection with poorly defined margins
chronic:
- complex
- internal debris
- doppler - increased flow in thickened wall
what are disorders of joints?
- tissues involved in diseases of synovial joints are sunovial membrane, hyaline cartilage, and bone
what is arthritis?
inflammation of one or more joints
what is Rheumatoid arthritis?
- chronic progressive inflammatory autoimmune disease mainly affecting peripheral synovial joints
- systemic disorder in which inflammatory changes affect not only joints but also many other sites including the heart, blood vessels and skin
Rheumatoid arthritis risk factors?
- gender
- age
- more common in females than males
- can affect all ages, including children (Still’s disease), usually develops between the ages of 35 and 55 years
what is rheumatoid factor?
- 90% of cases will have this
- High levels of RF, especially early in the disease, are strongly associated with accelerated and more severe disease
- Symptoms include joint pain and stiffness, particularly in the morning and after rest
- Joints can be visibly swollen, hot and tender
Rheumatoid arthritis- most commonly affected joints? 2
- hands and feet
What is growth of inflammatory granulation tissue, pannus?
distorts the joint and destroys articular cartilage, exposing the bone below and causing further damage. Fibrosis of the pannus reduces joint mobility
what is Osteoarthritis?
- degenerative non-inflammatory disease that results in pain and restricted movement of affected joints
- early stages, often asymptomatic.
- very common, with the majority of over-65s showing some degree
- articular cartilage gradually becomes thinner because its renewal does not keep pace with its breakdown
- bony articular surfaces come in contact and the bones begin to degenerate, the articular surfaces become misshapen
- chronic inflammation develops with effusion
- abnormal outgrowth of cartilage at the edges of bones becomes ossified, formingosteophytes.
what bones does osteoarthritis mainly affect?
- affects large weight-bearing joints, i.e. the hips, knees and joints of the cervical and lower lumbar spine
- many cases only one joint is involved
what is gout caused by?
the deposition of sodium urate crystals in joints and tendons, provoking an acute inflammatory response
gout risk factors?
- more prevalent in males than females
- familial tendency
- obesity
- hyperuricemia
- high alcohol intake
what is primary gout?
commonest form, almost always in men ,associated with reduced ability to excrete urate or increased urate production
what is secondary gout?
consequence of diuretic treatment or kidney failure, both of which reduce urate excretion.
gout s/s?
many cases only one joint is involved (monoarthritis)- red, hot and extremely painful
gout- sites most commonly affected?
metatarsophalangeal joint of the big toe and the ankle, knee, wrist and elbow joints
gout complications?
development of renal calculi
Effusions?
- appear as black collections of fluid within the joint space
- usually clinically evident, but may be subtle
- presence of irregular internal echoes or material may indicate pus, fibrinous material, or a complicated effusion
what is osteomyelitis?
- bacterial infection of bone
- follow an open fracture or surgical procedures, which allow microbial entry through broken skin
- consequence of blood-borne infection from a focus elsewhere, such as the ear, throat or skin; most commonly seen in children
- infection can resolve without permanent damage, or become chronic, with sinus formation draining pus to the skin, fever and pain
Benign tumours?
- Single or multiple tumours may develop for unknown reasons in bone and cartilage
- may cause pathological fractures or pressure damage to soft tissues, e.g. a benign vertebral tumour may damage the spinal cord or a spinal nerve
- benign tumours of cartilage have a tendency to undergo malignant change
apperance of Giant cell tumor?
- demonstrated varied appearances (hypoechoic, hyperechoic, or mixed) with increased vascularity on Doppler USG.
- Posterior acoustic enhancement may be seen in some giant cell tumors
Osteochondroma?
part of thegrowth platewhich separates and continues growing independently, without an associated epiphysis, usually away from the nearby capped byhyaline cartilage
Osteochondroma account of what % of bone tumors and what % of benign bone tumors?
very common and account for 10 - 15% of allbone tumoursand 20 - 50% of all benign bone tumours
Osteochondroma sono apperance?
cartilage cap seen as a hypoechoic region bounded by bone on its deep surface and muscle / fat superficially
Chondrosarcoma?
- relatively slow-growing tumours -usually the result of malignant change in benign tumours of cartilage cells
- occur mainly between the ages of 40 and 70 years
fractures sono apperance?
- Fractures appear as a sharp discontinuity of the bright line of boney cortex.
- Sometimes hypoechoic hematoma/effusion of the immediately surrounding soft tissue is visible as well
what are myopathies?
muscle disorders
what is a strain?
injuries to skeletal muscles caused by overexertion or trauma
how are muscle strains characterized?
muscle pain, ormyalgia, and involve overstretching or tearing of muscle fibers
whats a sprain?
- injury occurs in the area of a joint and ligament is damaged
what is myositis?
- muscle inflammation, including that caused by a muscle strain
what is fibromyositis?
- tendon inflammation occurs with myositis
Ultrasound-guided musculoskeletal soft tissue biopsies?
- Image-guided MSK biopsies- safe, minimally invasive, effective, lower risks compared with open biopsies, offer high diagnostic results
- procedure is done under local anesthetic
- patient’s biopsy site is then prepared in a sterile manner
- ultrasound probe is covered with a sterile bag containing small amount of sterile gel as a coupling agent
- sterile gel is then placed on the patient’s site of biopsy
Ultrasound-guided Injections?
- Cortisone is a type of steroid that is produced naturally by adrenal gland
- inject a corticosteroid medication around a tendon to relieve tendinitis
reduce inflammation, help ease pain - work within a few days, and the effects canlast up to several weeks
- repeated injections may weaken a tendon, increasing your risk of rupturing the tendon
Arthrocentesis?
- joint aspiration - procedure whereby a sterile needle and syringe are used to drain fluid from the joint
- Analysis of joint fluid can help to define causes of joint swelling orarthritis, such as infection,gout, andrheumatoid disease, as well as cultured to detect infection
