MSK path Flashcards
What are risk factors for tendon ruptures?
aging, calcs, corticosteroid therapy and systemic disease like lupus, diabetes or gout
How to partial tears appear?
hypoechoic defects with fibular disruption
intrasubstance tears (most often in ankle) appear like longitudinal hypoechoic cleft
What are indirect signs of partial tears?
thickened bursa and fluid in the tendon sheath
What type of tendon tears are rare?
tears from traumas, especially complete
What are avulsions?
a forcible separation or detachment/tearing away a body part
occurs when a muscle or tendon is torn away from bone (bone fragments in muscle may be seen)
What is tendinosis? What does tendinosis have a strong relationship with?
degenerative changes without signs of inflammation
repetitive microtrauma of overuse injuries (sports)
What are the signs of tendinosis?
(what do you see?)
painful focal or diffuse nodular thickening of the tendon, most often in patellar tendon and achilles
CD shows vascularity (representing neovascularity)
How do tendinosis lesions appear?
focal or diffuse areas of decreased echogenicity and tendon enlargement
achilles: usually in middle 3rd
patellar: at upper insertion point
What is tendonitis?
edema associated with inflammation and causes thickening and decreased echogenicity of tendons (can affect whole tendon or part)
How does acute tendinitis appear?
thickened, decreased echogenicity with poorly defined margins, increased in vascularity within tendon
What rules out a tear vs tendonitis?
How does chronic tendinitis appear?
presence of blood flow rules out tear
margins are deformed and bumpy, may have intra-tendinous calcs
What is tenosynovitis?
inflammation of the tendon sheath, mot often in tendons of hand, wrist and ankle
What causes acute tenosynovitis most often?
How does it appear?
repetitive microtrauma and pyogenic infection (can be caused by FB in tendon sheath)
appears as fluid in the sheath, may have internal echoes (pus)
What type of tenosynovitis causes rapid degeneration?
suppurative: can be caused by foreign bodies
How does chronic tenosynovitis appear and what does it cause?
hypoechoic thickening of synovial sheath with little or no fluid
causes impaired tendon movement
What is enthesopathy?
When is it usually seen (what disease path)
inflammation of insertion point of tendons onto bones
usually seen in spondyloarthopathies
Where is enthesopathy common?
pateller and achilles tendons, also plantar fascia
how does enthesopathy appear?
swollen and hypoechoic, with calcs in chronic lesions
can often cause bursitis
Where do synovial tumors arise from?
what do they look like
tendon sheath
show as irregular or lobulated hypoechoic masses with calcs
Are giant cell tumors of tendon sheaths benign or malignant?
how do they appear?
benign tumors, usually on fingers of young/middle aged women
hypoechoic masses with lobulated contours, increased internal vascularity
What are pseudotumors?
how do they appear
palpable rheumatoid nodules on the hands (think cramped up old ladies)
ill defined and heterogenous, compressible with no posterior shadowing and no Doppler
How do lipomas appear?
Where are they most often seen?
homogenous, oval, isoechoic masses with little/no flow on CD, soft and pliable with pressure
shoulder, upper extremity, trunk and back. can be in subcutaneous fat, within muscle or within tissue planes
What pathology is it important to have 90* insonation angle for?
foreign bodies
FB’s that cause infection will have a halo appearance and hyperemia, fluid can be seen with hemorrhage or abscess
How does nerve entrapment show?
hypoechoic swelling of nerve at the entrapment site
possible compression distally, pain with pressure
What is bursitis?
inflammatory irritation of bursa which causes pain and accumulation of fluid in the bursa, often caused by trauma
Describe the appearance of acute bursitis vs chronic bursitis
acute: sonolucent, fluid filled collection with poorly defined margins
chronic: hypervascular in walls and complex appearance with internal echogenic debris from granulomatous tissue, fibrin and calcs
What does bursitis often occur in the presence of?
tendinosis
What is a ganglion cyst and where are they most commonly found?
benign lumps developing in a joint or tendon sheath
most common in wrist or hand
Is a ganglion cyst compressible or non compressible?
non compressible, has simple appearance to normal cysts that are adjacent to a joint space/tendon
When can a ganglion cyst mimic a solid tumor?
when they become chronic and have internal echoes
What is a bakers cyst?
how does it present?
cyst that communicates with the knee joint, caused by abn distention of the gastroc-semimenbranous bursa
presents as popliteal mass, a ruptured mass may cause limb swelling and mimic a venous thrombus
What is a bakers cyst associated with? (disease process)
What can be seen in a bakers cyst?
pathological conditions that increase synovial fluid production (RA may make cyst look like a solid mass from vascular fibrous tissues)
internal echoes may represent an infected cyst, might have internal mobile calcs
What is the most common muscle pathology?
tears
What sign does a complete MUSCLE tear have?
clapper in the bell sign: retracted muscle surrounded by fluid
What is an acute tear?
list the grading for muscle tears
-direct impact, penetrating or a stretch injury
grade 1- no appreciable fiber disruption
grade 2- partial tear or moderate fiber disruption with compromised strength
grade 3- complete fiber disruption with retraction
How does muscle hemorrhage appear?
initially hyperechoic, then liquifies
acute appearance: anechoic and becomes smaller as reabsorbed
chronic: becomes echogenic around edges
What can hematomas create within the muscle and how does it appear?
can create scars or calcs, appears hyperechoic
How does an acute bone fracture appear on u/s?
discontinuity of cortex with step off deformity
How does a stress fracture appear?
may appear as focal hypoechoic area adjacent to bone, then progress to fracture step off deformity or callus formation
