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MSK path Flashcards

1
Q

What are risk factors for tendon ruptures?

A

aging, calcs, corticosteroid therapy and systemic disease like lupus, diabetes or gout

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2
Q

How to partial tears appear?

A

hypoechoic defects with fibular disruption

intrasubstance tears (most often in ankle) appear like longitudinal hypoechoic cleft

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3
Q

What are indirect signs of partial tears?

A

thickened bursa and fluid in the tendon sheath

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4
Q

What type of tendon tears are rare?

A

tears from traumas, especially complete

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5
Q

What are avulsions?

A

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)

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6
Q

What is tendinosis? What does tendinosis have a strong relationship with?

A

degenerative changes without signs of inflammation

repetitive microtrauma of overuse injuries (sports)

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7
Q

What are the signs of tendinosis?

(what do you see?)

A

painful focal or diffuse nodular thickening of the tendon, most often in patellar tendon and achilles

CD shows vascularity (representing neovascularity)

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8
Q

How do tendinosis lesions appear?

A

focal or diffuse areas of decreased echogenicity and tendon enlargement

achilles: usually in middle 3rd
patellar: at upper insertion point

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9
Q

What is tendonitis?

A

edema associated with inflammation and causes thickening and decreased echogenicity of tendons (can affect whole tendon or part)

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10
Q

How does acute tendinitis appear?

A

thickened, decreased echogenicity with poorly defined margins, increased in vascularity within tendon

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11
Q

What rules out a tear vs tendonitis?

How does chronic tendinitis appear?

A

presence of blood flow rules out tear

margins are deformed and bumpy, may have intra-tendinous calcs

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12
Q

What is tenosynovitis?

A

inflammation of the tendon sheath, mot often in tendons of hand, wrist and ankle

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13
Q

What causes acute tenosynovitis most often?
How does it appear?

A

repetitive microtrauma and pyogenic infection (can be caused by FB in tendon sheath)

appears as fluid in the sheath, may have internal echoes (pus)

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14
Q

What type of tenosynovitis causes rapid degeneration?

A

suppurative: can be caused by foreign bodies

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15
Q

How does chronic tenosynovitis appear and what does it cause?

A

hypoechoic thickening of synovial sheath with little or no fluid
causes impaired tendon movement

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16
Q

What is enthesopathy?
When is it usually seen (what disease path)

A

inflammation of insertion point of tendons onto bones
usually seen in spondyloarthopathies

17
Q

Where is enthesopathy common?

A

pateller and achilles tendons, also plantar fascia

18
Q

how does enthesopathy appear?

A

swollen and hypoechoic, with calcs in chronic lesions

can often cause bursitis

19
Q

Where do synovial tumors arise from?
what do they look like

A

tendon sheath
show as irregular or lobulated hypoechoic masses with calcs

20
Q

Are giant cell tumors of tendon sheaths benign or malignant?
how do they appear?

A

benign tumors, usually on fingers of young/middle aged women

hypoechoic masses with lobulated contours, increased internal vascularity

21
Q

What are pseudotumors?
how do they appear

A

palpable rheumatoid nodules on the hands (think cramped up old ladies)

ill defined and heterogenous, compressible with no posterior shadowing and no Doppler

22
Q

How do lipomas appear?
Where are they most often seen?

A

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

23
Q

What pathology is it important to have 90* insonation angle for?

A

foreign bodies

FB’s that cause infection will have a halo appearance and hyperemia, fluid can be seen with hemorrhage or abscess

24
Q

How does nerve entrapment show?

A

hypoechoic swelling of nerve at the entrapment site
possible compression distally, pain with pressure

25
Q

What is bursitis?

A

inflammatory irritation of bursa which causes pain and accumulation of fluid in the bursa, often caused by trauma

26
Q

Describe the appearance of acute bursitis vs chronic bursitis

A

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

27
Q

What does bursitis often occur in the presence of?

A

tendinosis

28
Q

What is a ganglion cyst and where are they most commonly found?

A

benign lumps developing in a joint or tendon sheath
most common in wrist or hand

29
Q

Is a ganglion cyst compressible or non compressible?

A

non compressible, has simple appearance to normal cysts that are adjacent to a joint space/tendon

30
Q

When can a ganglion cyst mimic a solid tumor?

A

when they become chronic and have internal echoes

31
Q

What is a bakers cyst?
how does it present?

A

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

32
Q

What is a bakers cyst associated with? (disease process)
What can be seen in a bakers cyst?

A

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

33
Q

What is the most common muscle pathology?

A

tears

34
Q

What sign does a complete MUSCLE tear have?

A

clapper in the bell sign: retracted muscle surrounded by fluid

35
Q

What is an acute tear?
list the grading for muscle tears

A

-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

36
Q

How does muscle hemorrhage appear?

A

initially hyperechoic, then liquifies
acute appearance: anechoic and becomes smaller as reabsorbed
chronic: becomes echogenic around edges

37
Q

What can hematomas create within the muscle and how does it appear?

A

can create scars or calcs, appears hyperechoic

38
Q

How does an acute bone fracture appear on u/s?

A

discontinuity of cortex with step off deformity

39
Q

How does a stress fracture appear?

A

may appear as focal hypoechoic area adjacent to bone, then progress to fracture step off deformity or callus formation

MSK (9 decks)

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