MSK Pathology Flashcards
What pathology in tendons are the final stage of progressive destruction of fibers?
Rupture
What are 2 INDIRECT signs of a partial thickness tear?
- Bursal thickening
- Fluid in tendon sheath
What pathology is defined as ‘forcible separation or detachment’ or ‘tearing away a body part’
Avulsions - when tendon or muscle is pulled away from the bone and bone fragments are seen within the muscle or tendon
What pathology is defined as “degenerative changes w/out signs of inflammation”
Tendinosis - caused by repetitive microtrauma of overuse injuries
With color and power doppler, does Tendinosis have blood flow occurring at the deep or superficial side of the tendon?
Deep side - neovascularity
What Tendon’s are usually affected by tendinosis?
Patellar tendon - jumpers knee - usually affects the upper insertion of the tendon
Achilles tendon - usually affects the middle 1/3rd of the tendon
What tendon is involved in ‘jumpers knee’?
Patellar tendon
What pathology is defined as “edema associated w/ inflammation and causes thickening and decreased echogenicity of tendons”
Tendonitis
SF of acute tendonitis?
- Decreased echogenicity
- Thickened
- Irregular margins
- Increased vascularity within the tendon
SF of chronic tendonitis?
- Deformed tendon margins/bumpy appearance
- Intra-tendon calcifications
What pathology is known as the inflammation of the tendon sheath?
Tenosynovitis
What 3 locations does synovitis typically occur?
- Hand
- Wrist
- Ankle
Acute cases of tenosynovitis are most often caused by what two things?
- Pyogenic infection
- Microtrauma
What are the acute vs. chronic SF of tenosynovitis?
Acute - fluid in sheath
Chronic - thickened sheath with some or no fluid
What pathology is defined as the “inflammation of the 2 tendons and their sheath that control the movement of thumb over the radius”?
De-Quervain’s tenosynovitis- affects compartment 1
What pathology is defined as inflammation of the INSERTION of tendons on to bones?
Enthesopathy
Enthesopathy is most common at what 3 sites in the body?
- Achilles tendon
- Patellar tendon
- Plantar Fascia
T or F? Soft tissue tumors are cell growths that emerge anywhere in the body?
TRUE
On ultrasound while scanning the index finger, you see a hypoechoic mass with lobulated contours on a 40 year old woman with internal vascularity. What is the most likely diagnosis? slide 14
Giant cell tumor of the tendon sheath which is BENIGN
What is the name of the malignant tumor that arises from the tendon sheath?
Synovial Sarcomas - hypoechoic mass, lobulated, with calcifications
What pathology is seen when a nodule is compressible with transducer pressure and has NO posterior shadowing or color flow?
Pseudo-tumour
What MSK pathology appears as a homogeneous, oval, isoechoic mass, with little or no flow on color or power Doppler imaging, soft and pliable with transducer pressure?
Lipoma
Foreign Body appearance over time?
Acute <3 days: Hyperechoic with posterior shadow due to air
Intermediate 3-10 days: Hypoechoic halo surrounding foreign body - air replaced with fluid
Chronic >10 days: Granulation formation and may have a shadow
What are the SF of nerve entrapment?
- Hypoechoic swelling of the nerve proximally at entrapment site
- Distal compression of the nerve
- Pain with transducer pressure
What is the most common cause of bursitis?
Trauma
Often occurs in the presence of Tendinosis
Acute vs chronic SF of bursitis?
Acute - Fluid collection
Chronic - Hypervascular walls, complex, debris, possible calcifications
What pathology is composed of benign lumps that develop from a joint or tendon sheath, most commonly found in the hand or wrist?
Ganglion cysts - anechoic round appearance and filled with a hard jelly-like substance - are NOT compressible
What pathology is caused by abnormal distension of the gastrocnemiosemimembranous bursa, which communicates w/ knee joint?
Baker’s cyst - medial gastrocnemius and semi- membranous tendon
A tear of the muscle is the most common muscle pathology and is often associated with what?
Hematoma
What pathology demonstrates a ‘clapper in a bell’ sign?
Complete muscle tear - retracted muscle surrounded by a hematoma
What are the 3 grades of acute muscle injury?
Grade 1: No fiber disruption seen
Grade 2: Partial tear, moderate fiber disruption, compromised strength
Grade 3: Complete fiber disruption and retraction
What are the 3 types of muscle injuries?
- Direct - usually muscle demonstrates disorganized fibers
- Stretch - common where muscles spans over two joints
- Penetrating - usually result in partial or full thickness tears. Gas can be introduced into the injury site.
Which muscle injury is most common in children?
Stretch injury
SF of chronic muscle injury?
Hyperechoic and atrophied muscle
A damaged muscle can ossify and you will be able to see the mineralization on U/S before CT. What is this called? (called myositis ossificans)
Myositis Ossificans
SF of hemorrhage by stage?
Initial injury - hyperechoic
After 36+ hours - becomes anechoic as it liquifies and becomes smaller as it reabsorbs
Chronic - Becomes echogenic at surrounding edges
What are the different types of bone fractures?
Acute fracture - discontinuity of the bone and often seen with hemorrhage
Stress fracture - Focal hypoechoic area beside bone - patient may feel focal pain and tenderness
Osteophytes or bone spurs - bony growths occurring at margins of synovial joints - usually DO NOT present with tenderness or pain
