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radiology > msk trauma > Flashcards

msk trauma Flashcards

1
Q

2 stress fractures

A

1) fatigue

2) insufficiency

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2
Q

tuft fx w/ disruption of nail plate-mx?

A

“open” but no OR, just abx

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3
Q

phases of fracture healing

A

1) inflamm
2) reparative
3) remodeling
* gran tissue at 7-14 d = MORE LYTIC

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4
Q

fracture healing-fastest, normal, slowest

A
  • phalanges- 3 wks
  • most-6-8 wks
  • tibia-10 wks (slowest)
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5
Q

abnormal healing

A

1) delayed-2x as long
2) non-union-will not heal without intervention. 6-9 mo
3) mal union

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6
Q

classic locs for “non-union” fx

A
  • scaphoid
  • ant tibia
  • lat femoral neck
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7
Q

RFs for abnormal fracture healing

A
  • vit D
  • gastric bypass
  • drugs/mx-smoking, nsaids, prednisone (steroids)
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8
Q

stress fracture compressive vs tensile sides healing

A

compressive-pushed together, heal well

tensile- pulled apart, no bueno

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9
Q

tibia compressive vs tensile side

A
  • compressive=pst (MC), prox or distal 3rd

- tensile= ant mid shaft. “dreaded black lines”

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10
Q

MC stress fx in young athlete

A

tibia

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11
Q

femoral neck compressive vs tensile side

A

C=medial (MC), younger, inferior femoral neck

-T=lateral; oder people

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12
Q

SONK-what, who, where

A

“spon’t osteonecrosis of knee”

  • stress fx in the medial femoral condyles that progressed to subchondral collapse with 2˚ osteonecrosis
  • atraumatic, typically affecting older adults.
  • Actually spon’t INSUFFICIENCY, ie: SINK
  • medial femoral condyle (max wt bearing) + meniscal
  • UL
  • atraumatic in old lady
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13
Q

most fractured tarsal bone

A

calcaneus (75% intraairticular)

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14
Q

orientation calcaneal stress fx

A

perpendicular

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15
Q

which tarsal is at risk for AVN?

A

navicular

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16
Q

march fracture

A

metatarsal stress fx seen in recruits marching all day

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17
Q

stress fx to know…

A
  • tibia (mc)
  • calcaneus (perpendicular to trabeculae)
  • navicular-risk AVN
  • march fx= metatarsal (recruits marching all day)
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18
Q

high vs low risk stress fx based on healing

A

High: lateral femoral neck (tensile side), ant tib mid shaft (tensile side), transverse patellar fx, 5th MT, talus, navicular, sesamoid GT

Low: medial femoral neck (compressive side), pst prox/distal 3rd tibia (C side), long patellar fx, 2nd & 3rd MT, calcaneus

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19
Q

how do you know wrist xray is true lateral?

A

palmar cortex of pisiform centrally btw palmar cortex of scaphoid & capitate

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20
Q

BF to scaphoid retrograde? why is it retrograde

A
  • dorsal carpal branch of radial artery

- 80% covered by cartilage

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21
Q

which age group most susc to scaphoid fx age group

A

-adol/young adults (grandma more likely to get distal radial fx with similar mechanism)

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22
Q

1st sign avn

A

sclerosis

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23
Q

mc scaphoid fx site.

A

waste

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24
Q

prieser dx

A

atraumatic avn of scaphoid

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25
Q

Mx scaphoid fx displacement >1mm

A

fixation screw

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26
Q

perilunate dislocation ass injury

A
  • 60% scaphoid fx

- hutchinson/chauffeur fx

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27
Q

scapholunate ligament disruption-sign, distance, ass injuries

A
  • Terry thomas.
  • > 3 mm. worsened with clenched view
  • 10-30% ass/ with distal radius/carpal fx (ex: radial styloid)
  • chronic –> SLAC, SNAC, capitate migration, DISI
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28
Q

scapholunate ligament-parts, ass pathology

A
  • volar, dorsal (MI for stability), middle
  • ass radial/carpal fx
  • DISI
  • SLAC wrist
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29
Q

SLAC causes

A
  • trauma

- CPPD

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30
Q

scaphoid fracture compl/associated injuries

A
  • AVN
  • perilunate disloc
  • SLAC –> Scaphoid Non-Union Advanced Collapse –> DISI

Scaphoid Nonunion Advanced Collapse (SNAC) describes the specific pattern of progressive arthritis of the wrist that results from a chronic scaphoid nonunion.

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31
Q

normal scaphoid-lunate angle

A

30-60 degrees

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32
Q

DISI

A

dorsal intercalated segmental instability=-radial sided injury (scapholunate).

  • dorsiflexion instability
  • lunate comes free of stabilizing scaphoid and rocks dorsally
  • widening of SL angle
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33
Q

VISI

A

volar intercalated segmental instability

  • problem with lunotriquetral lig/ulnar side)
  • lunate tilts volar –> SL angle <30˚
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34
Q

spectrum carpal dislocation severity

A

SL –> perilunate –> mid-carpal –> lunate (alphabetical)

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35
Q

humpback deformity

A

angulation prx & distal scaphoid fragments due to fracture at waste –> no-union, collapse
-ass w/ DISI

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36
Q

DISI ass

A
  • scaphoid fx, humpback deformity

- SNAC & SLAC

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37
Q

treatment SNAC/SLAC

A
  • wrist fusion- strength; no mobility

- prox row carpectomy-mobility, no strength

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38
Q

mid carpal dislocation ass injuries

A
  • triquetro-lunate interosseous ligament disruption

- triquetrium fx

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39
Q

lunate dislocation ass injuries

A

occurs with a dorsal radiolunate ligament injuries

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40
Q

carpal dislocated around lunate vulnerable zones theory

A
  • lesser arc-purely lig injury
  • greater arc-fx+ (“trans-scaphoid, perilunate dislocation”)
  • space of poirier-lig free (Poor), site of weakness
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41
Q

which synovial spaces in hand communicate and how it that demonstrated?

A
  • pisiform recess & radiocarpal joint
    1) fluid in pisiform recess okay in setting of RC eff
    2) entry sites for wrist arthrography
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42
Q

GH joint and subacromial bursa

A

full thickness rotator cuff tear

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43
Q

ankle joint and common (lateral) perineal tendon sheath

A

calcaneofibular ligament tear

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44
Q

achilles tendon and pst subtalar joint

A

should not communicate.

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45
Q

DRUJ

A

distal radioulnar joint

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46
Q

1˚stabilizer & shock absorber of DRUJ

A

triangular fibrocartilage complex (TFCC)

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47
Q

TFCC 5 components

A

1) triangular fibrocartilage-articular disc
2) volar & dorsal radioulnar ligaments
3) meniscus homologue
4) ULC
5) tendon sheet of UCL

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48
Q

TFCC injuries

A 
class I-acute (fall on extended wrist)
class II-chronic/degenerative
*ulnar side more likely to heal
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49
Q

tfcc class II injury association

A

positive ulnar variance, ulnar impaction, central perforation, lunate abutment (cystic change)

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50
Q

ulnar positive and negative variance ass

A

(+)-ulnar impaction syndrome

(-)-kienbock

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51
Q

ulnar impaction syndrome/ulnar abutment

A

ulnar –< lunate –> cystic change + TFCC tears

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52
Q

next step colles fx old man

A

DEXA

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53
Q

colles fx ass injury

A

ulnar styloid 50%

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54
Q

wrist fractures to know & high yield

A

1) colles- outward (collie dogs like it outside). ulnar styloid 50%. old ppl
2) smith (reverse colles 85%, reverse barton 15%)- +US fx. young people
3) barton (dorsal), reverse barton (volar, MC)-intraarticular. radiocarpal disloc = HM. sx repair
4) hutchinson/chauffeur-intraart radial styloid. SL diss, perilunate disloc

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55
Q

radial tilt

A

volar, 11˚

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56
Q

extensor pollicis longus rupture

A

3wk-3mo post distal radial fx via irreg Lister’s/dorsal radial tubercle
*MC in non-displaced fx

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57
Q

6 wrist extensor compartments

A

1) APL, EPB-de Quervain’s
2) ECRB, ECRL
3) Lister’s tubercle –> delayed EPL rupture s/p non-displaced radial fx
4) EDC, EIP
5) Extensor digiti minimi-start of Vaughan-jackson syndrome
6) extensor capi ulnaris-early tensosynovitis in RA & sub-sheet tear/disloc

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58
Q

carpal tunnel contents

A

-4 flexor D profundus
-4 flexor D superficialis
-1 median nerve
-1 flexor pollicis longus
NOT: FCR, FCU, FPB, palmaris (if you have 1)

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59
Q

carpal tunnel syndrome expected findings

A
  • BL n enlargement, increased signal, smashed/flattened
  • “bowing of flexor retinaculum
  • median n paresthesia (thumb –> radial 4th phalynx)
  • thenar atrophy
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60
Q

carpal tunnel associations

A

-dialysis, pregnant, DM, hypoTh

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61
Q

Guyon’s canal

A

pisiform and hamate

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62
Q

guyon canal syndrome

A

ulnar n

-money bars & hook of hamate

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63
Q

sub-sheath tear/dislocation-what, dir of disloc

A
  • extensor capi ulnari MEDIAL disloc from normal groove

- implies rupture of overlying sheath

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64
Q

vaughan-jackson syndrom

A

sequential extensor tendon ruptures ulnar –> radial starting at compartment 5 (EDM)
-seen with worsening RA

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65
Q

things to think of on MRI wrist

A

1) EPL rupture (after fx)
2) carpal tunnel syndrome-overuse
3) Guyon’s canal syndrome-money bars
4) sub-sheath tear/dislocation-trauma
5) vaughan-jackson syndrome-RA
6) tenosynovitis- myobacterium/ RA, inf, overuse (de quervain’s, intersection syndrome (ECB, ECL), drummer’s wrist EPL))

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66
Q

wrist tenosynovitis

A

diffuse (Tb or non MB, RA)
focal-infection, overuse
overuse=de quervain’s, intersection, drummers

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67
Q

Tb/non TB myobacterium wrist tenosynovitis

A
  • hand/wrist MC tendons
  • spares m
  • rice bodies
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68
Q

RA wrist tenosynovitis

A
  • diffuse, early (bf bone!)
    1) multiple flexor tendons
    2) isolated extensor carpi ulnaris (comp 6)
    3) vaughan jackson
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69
Q

intersection syndrome

A
  • rowers

- 1st comp intersects the 2nd –> extensor carpi radialis breves & long tenosynovitis

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70
Q

drummers wrist

A

3rd compartment (EPL)

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71
Q

wrist tenosynovitis focal infection

A
  • surgical emergency if flexor tendon

- myocbacterium marinum

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72
Q

Bennett & rolando

A

base of 1st metacarpal

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73
Q

tendon involved in Bennett fracture dorsolateral dislocation

A

abductor pollicis longus

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74
Q

gamekeeper/skiers thumb

A
  • base of 1st proximal phalanx
  • ulnar collateral ligament disruption
  • stener lesion
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75
Q

stener

A
  • adductor tendon aponeurosis caught in torn edge of UCL in a gamekeeper/skier’s thumb
  • yo yo on MRI
  • sx (for lig healing)
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76
Q

trigger finger/stenosis tenosynovitis

A
  • over use flexor tendon –> thickening of sheath

- equivalent to os trigonometry syndrome of ankle

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77
Q

forearm fx eponyms

A
  • monteggia- prox ulnar fx + ant disloc prox radial head
  • galeazzi- distal radial shaft + ant distal ulnar disloc
  • essex-lopresti-prx RH fx + ant disloc DRUJ
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78
Q

accessory aconeus/aconeus epitrochlearis.

A

-medial elbow accessory m –> ulnar n compression

The anconeus epitrochlearis is an accessory muscle at the medial aspect of the elbow. It is also known as the accessory anconeus muscle or epitrochleoanconeus muscle and should not be confused with the anconeus muscle which is present at the lateral aspect of the elbow.

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79
Q

aconeus

A

?accessory m usually on lateral elbow

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80
Q

lateral epicondylitis

A
  • tennis.
  • varus stress
  • extensor carpi radialis brevis & RCL
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81
Q

medial epicondylitis

A
  • golf
  • valgus stress
  • common flexor tendon, ulnar nerve
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82
Q

which is more common? lateral or medial epicondylitis?

A

lateral

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83
Q

partial ulnar collateral ligament tear

A
  • throwers via valgus stress

- anterior bundle w/ contrast tracking medial to tubercle–> T-sign

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84
Q

things to think about with elbow MRI

A
  • accessory aconeus/aconeus epitrochlearis
  • lateral epicondylitis
  • medial epicondylitis
  • partial ulnar collateral ligament tear
  • little leaguer elbow
  • valgus overload syndrome
  • epitrochlear LAD
  • dialysis elbow
  • bicep/tricep tear
  • pst disloc
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85
Q

UCL attachment

A

-medial coronoid sublime tubercle

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86
Q

little leaguer elbow

A

-chronic valgus stress –> medial eippcondyle injury (fx, delayed closure, etc)

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87
Q

valgus overload syndrome

A
  • adult throwers
  • lateral compression, medial tension, pst sheer–> triad:
    1) UCL injury
    2) pst humerus/ulna arthritis
    3) capitellum OCD
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88
Q

dialysis elbow

A

olecranon bursitis

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89
Q

bicep injury related to what n injury

A

median

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90
Q

tricep rupture

A
  • rare (least common in body)

- SH II fx of olecranon

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91
Q

elbow dislocation

A
  • 2nd MC
  • radial head & coronoid process
  • “tear LUCL –> partial dislocation (coronoid perched on tracheal) –> total w/ UCL tear
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92
Q

total shoulder arthroplasty complications

A

1) loosening glenoid component-MC
2) anterior escape-ant migration HH after subscapularis fx
3) pst acromion fx (deltoid tugging)

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93
Q

subacromial impingement

A
  • mc.
  • supraspinatus tendon
    1) OP
    2) coracoacromial lig thickening
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94
Q

subcoracoid impingement

A

coracoid & lesser tub decreased dist –> subscap

-cong or post traumatic

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95
Q

hooked acromion

A

type III

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96
Q

internal RC impingement

A

1) pst sup: GT & pst sup labrum torn + –> infraspinatus (pst supraspintus) dam+ cystic GT. Throwers. ABER position.
2) ant-adduction & internal rotation –> bicep and subscap

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97
Q

RC tear sides

A

articular > bursal

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98
Q

critical zone supraspinatus tear

A

1-2 cm from tendon footprint. MC

-also mc HADD/calcific tendinitis

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99
Q

“massive rotator cuff tear”

A

-2/4 RC m’s

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100
Q

how do you know you have full thickness tear?

A

gad in bursa

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101
Q

rotator cuff interval

A

spot with bicep tendon btw supra spinouts and subscap

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102
Q

multi-directional GH instability

A

type of RC impingement (2˚ external cause, normal CA arch)

  • microsublux of humeral head in glenoid –> micro trauma.
  • seen in joint laxity often involving both shoulders)
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103
Q

adhesive capsulitis/frozen shoulder

A
  • loss of fat in RC interval, thickened axillary fold
  • GH volume decrease w/ injunction
  • thickened pstinf capsule
  • enhancement of rotator cuff interval
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104
Q

SLAP mimics

A

sublabral recess
sublabral foramen
Buford complex

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105
Q

how does management change with type 4 SLAP?

A

extends into bicep anchor (type 4): debridement + biceps tenodesis (vs just debridement)

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106
Q

SLAP tears-what, who

A
  • tear of superior labrum along AP dir that involves labrum at insertion of long head biceps
  • swimmers (overhead)
  • > 40 –> ass RC tear
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107
Q

buford complex ass finding

A

thickened middle GH lig

108
Q

bankart lesions

A

GLAD-mildest
Perthes-periosteum intact
ALPSA-periosteum intact
Bankart (osseous, cartilage)

109
Q

labrum tears not ass w/ instability

A
  • SLAP

- GLAD

110
Q

pst GH instability

A
  • reverse osseous bankart
  • POLPSA-opp ALPSA
  • Bennett lesion-extra-art curvilinear Ca ass w/ pst labral tears (POLPSA?)
  • kim’s lesion-incompletely avulsed/flattened/mashed
111
Q

Kim’s lesion

A
  • incompletely avulsed/flattened/mashed pst inf GH labrum

- testable: glenoid cartilage & pst labrum relationship preserved

112
Q

HAGL

A
  • “humeral avulsion GH ligament”
  • ant shoulder disloc
  • inferior lig
  • J sgx (vs normal U shaped inf GH recess)
113
Q

subluxation biceps tendon

A

-medial dislocation long head via transverse lig disruption ISO subscap tear

114
Q

cyst at suprascapular notch

A

hits nerve to both supraspinatus and infraspinatus

115
Q

cyst at spinoglenoid notch

A

hits nerve to infraspinatus

116
Q

quadrilateral space borders & syndrome

A
  • borders: teres minor above, major below, hum neck lateral, triceps medial
  • ax n compression from fibrotic bands –> teres minor atrophy
117
Q

personage turner syndrome

A

idiopathic involvement of brachial plexus

118
Q

RC tendon to attach (partially) to lesser tub?

A

subscap (also att to GT)

119
Q

general anatomy deltoid org and insertion

A
  • org: 3 heads-clavicle, acromion, lateral 2/3 scapular spine
  • insert: deltoid tuberosity of humerus
120
Q

femoral shaft fx etiology

A

medial= stress fx (medial=management)

lateral=bisphos. cortical thickening

121
Q

“foot in internal rotation”

A

pst dislocation hip (against dashboard)

122
Q

ant and pst columns acetabulum

A

IP & II lines forming upside down Y

123
Q

both column acetabular fracture problem

A

divides ilium prox to hip joint –> no articular surface of hip attached to axial skull

124
Q

corona mortis

A

anastomosis inf epigastric & obturator

125
Q

hip fracture most at risk of avn

A

displaced intracapsular

*degree of displacement (+) risk of avn

126
Q

isolated avulsion lesser trochanter

A

pathologic

127
Q

avulsion fx pelvis

A

1) iliac-abd
2) ASIS-satorius
3) AIIS-RA
4) GT-glute
5) LT-iliopsoas
6) ischium-hamstring
7) pubic symph- adductor

128
Q

IT band syndrome

A

fluid on both sides

129
Q

snapping hip syndrome types & w/u algorithm

A

-ext, int, intraart

130
Q

hip labral tears

A
  • anterosuper

- cysts

131
Q

largest bursa of body

A

iliopsoas. communicates w/ joint 15%

132
Q

iliopsoas bursitis

A

fluid mass ant to hip/femur

133
Q

CAM FAI

A
  • men

- bony on femur H/N

134
Q

knee lateral tendon complex

A
  • IT (insert on Gurdy’s tubercle of tibia)
  • bicep femoris (insert on fib)
  • LCL (insert on fib)
135
Q

femoroacetabular impingement

A

painful hip mvmt via femoral and acetabular deformities ?–> degen?

136
Q

pincer type FAI

A
  • young female athlete
  • pst acetabulum cross over ant
  • BW’s: coxa profunda, protrusion, ischial spine sign
137
Q

key component of pincer type FAI eval?

A

-coccyx must be centered at PS

138
Q

coxa profunda

A

acetabulum med to II line

139
Q

acetabular protrusion

A

femur medial to II line

140
Q

prominent ischial spine

A

triangular prj ischial spine medial to pelvic inset/IP line

141
Q

cross over sign

A

pst lip acetabulum (usually lateral) crosses over ant lip

142
Q

Classic FAI associations

A

Os acetabuli (40%)
Labral tears
early arthritis

143
Q

Os acetabuli-what, testable associations

A
  • unfused 2˚ ossification center

- ass: FAI, labral tears

144
Q

total hip arthroplasty complications

A

1)

145
Q

“Wolff’s law”

A
  • unloaded bone surrounding arthoplasty is resorbed (GT, calcar)
  • stress thru stem –> distal cortical thickening (zone 4)
  • MC w/ uncemented arthroplasty
  • fx if advanced

Stress shielding proximally may result in proximal osteoporosis and calcar resorption.
Stress loading distally may result in cortical thickening and bridging sclerosis at the tip of the prosthesis ( called pedestal).
In an effort to avoid these changes, most modern cementless prosthesis only have fixation proximally, so you usually will not find proximal stress shielding.
The distal part of the femoral prosthesis is not ‘loaded’, so there will be no distal stress loading.

The calcar femorale is a normal ridge of dense bone that originates from the postero-medial endosteal surface of the proximal femoral shaft, near the lesser trochanter. It is vertical in orientation, and the ridge projects laterally toward the greater trochanter. This ridge of bone provides mechanical support and aids in load distribution within the proximal femur.

146
Q

asyx complications of hip arthroplasty

A
  • stress shielding
  • aggressive granulomatosis
  • heterotopic ossification
147
Q

mc complaint hetertopic ossification s/p hip arthroplasty

A

hip stiffness

148
Q

mx before THA in ank sponk pts

A

low dose pox radiation bc so prone to heterotypic ossification

149
Q

creep

A

thinning of acetabular cup in dir of wt bearing (along fem neck towards spine), ie: medial (vs polyethylene cup wear)

150
Q

polyethylene cup abnormal wear

A

lateral thinning

Evidence of polyethylene wear, which appears as asymmetric positioning of the femoral head within the acetabular cup, often coexists with particle disease.

151
Q

MC indication THA revision

A

aseptic loosening

152
Q

aseptic loosening xray cut off

A

> 2mm or migration (varus tilt of femoral stem)

153
Q

subsidence

A
  • diagnostic of loosening
  • downward motion measured from tip of GT to superolateral shoulder of stem
  • I cm along femoral comp or 2yr progr
  • implants w/o collar
  • early failure
154
Q

particle disease aka

A

aggressive granulomatosis

  • wear –> inflamm –> lytic (smooth) & JE.
  • areas of wear & screws
  • late (~1-5 yrs)
155
Q

particle disease vs infection

A
  • SMOOTH

- no esr, crp

156
Q

app sacral insufficiency fracture on xray

A

occult

157
Q

causes sacral insufficiency fracture

A
  • OP (mc)

- Renal fx, RA, radiation, THA mech change

158
Q

mechanism segond fx

A

internal rotation & varus stress –> avulsion lateral tibial plateau at att of lateral collateral band

159
Q

reverse segond fx

A
  • medial tib plateau ass w/ PCL

- ext rot

160
Q

arcuate sgx

A

avulsion prox fibula at insertion arcuate ligament

PCL

161
Q

deep intercondylar notch sgx

A

depression lateral femoral condyle (terminal sulcus) occurring 2/2 impaction injury via ACL insuff/tear

162
Q

which knee ligs are susceptible to magic angle artifact?

A

PCL, patellar tendons

163
Q

magic angle phenomenon

A

intermediate sign via 55˚ angle to main magnet during short TE (ie: GRE, PD, T1)

  • NOT on T2
  • less at higher field strength via shorter T2 relaxation times)
164
Q

ACL associated injuries

A

1) lateral tibial plateau and tib spine fx
2) O’donoghue’s unhappy triad
3) kissing contusion, intercondylar notch
4) ant drawer sgx

165
Q

ACL associated injuries

A

1) lateral tibial plateau and tib spine fx
2) O’donoghue’s unhappy triad
3) kissing contusion, intercondylar notch
4) ant drawer sgx
5) plantaris rupture

166
Q

BW: celery stalk

A

T2/STIR app of acl mucoid degeneration

167
Q

BW: drumstick

A

T1 app of ACL mucoid degen

168
Q

pts with all mucoid degen are predisposed to…

A

ganglion cysts

169
Q

ACL repair: femoral and tibial tunnels

A
  • Tibial-should parallel and be pst to blumensaat line. Determines impingement.
  • Femoral tunnel-length and tension. Determines isometry.
170
Q

tibial tunnel-too steep, flat or ant

A
  • steep: impinged by femur on ext
  • flat-too lax, no stability
  • ant: pinching at anterior inferior intercondylar roof. “roof impingement”
171
Q

complications of acl repair

A
  • malpositioning
  • arthrofibrosis (16wks)
  • graft tear-flat angle, 4-8 mo
172
Q

arthrofibrosis s/p acl repair

A
  • diffuse
  • focal (mc, cyclops). low sign ball in Hoffa’s fat pad
  • “palpable audible clunk”
173
Q

acl graft tear

A

4-8 mo post op

  • flat angle
  • T2 sign ++
  • fbr discon’t
  • uncovering pst horn lat meniscus (2˚)
  • ant tib translation (2˚)
174
Q

Posterior lateral corner-contents, img of tear, sign

A
  • IT band, biceps femurs, LCL ,popliteus tenton
  • edema in fib head
  • failure of ACL graft
175
Q

pcl tear-app, next step

A
  • stretched, thick (>7mm)

- popliteal flow void

176
Q

radial tear signs

A
  • truncated triangle
  • cleft (most reliable)
  • ghost/absent triangle
177
Q

flap tear (parrot beak)

A

radial tear charing dir into long dir

178
Q

bakers cyst

A

btw semi membranous and medial head gastroc tendons

179
Q

bucket handle tear signs

A
  • “double PCL”

- not enough bow ties

180
Q

discoid meniscus app

A
  • coronal: ext into notch

- sag-3 consecutive bow ties

181
Q

discoid complications

A

meniscal tear

182
Q

“pediatric pt with meniscal tear”

A

discoid

183
Q

discoid meniscus loc and types

A
  • lateral

- wrisberg variant most prone to injury

184
Q

meniscocapasular separation

A

capsular lig of MCL complex deepest and weakest –> sep of meniscus and MCL

1) MLC tears
2) surgical EM

185
Q

meniscal ossicle

A

ossification of pst horn med men 2/2 trauma or dev

*radial root tear

186
Q

meniscofemoral ligaments

A

Wrisberg (in the back)

  • H ant
  • mimics of tears
187
Q

meniscal flounce

A

ruffled meniscus not ass w/ tears but looks like one

188
Q

patella disloc

A
  • lat
  • contusion: lat fem condyle & medial patella
  • MPFL tear
  • “trochlear dysplasia”-trochlea too flat
189
Q

patella alta classic ass

A

SLE, elderly, trauma, athletes, RA

190
Q

bw: “BL patellar rupture”

A

chronic steroids

191
Q

fat impingement syndrome of knee

A

T2+ Hoffa’s fat inf to patella

192
Q

class tib plateau fx

A

schatzker

-2 MC (split and depressed lateral plateau)

193
Q

pilon fx (tibial plafond)

A

talus impacts into tib –> comm, intrart distal tib fx + distal fib (95%)

194
Q

slowest healing bone in body

A

tib (also mc long bone fx)

195
Q

SH type: tillaux fx

A
  • 3
  • veritcal (medial epiph) –> horz (physics)
  • med–> lat
196
Q

SH type: triplane fx

A

4

197
Q

direction of fox’s in triplane fx

A

vert epiph
horz physics
oblique metaph

198
Q

Maisonneuve fx

Monteggia fx

A 
Masonneuve= LE
Monteggia = UE
199
Q

Maisonneuve fx -what, mech, sgx’s, next step

A
  • medial tib malleolus and disruption of distal tibfib syndesmosis. no ext into hind foot.
  • unstable
  • mech: tibiotalar joint –> syndesmosis –> prox fib
  • wide medial malleolus. +/- deltoid
  • next step: img prox fib
200
Q

next step: Casanova fx

A

img spine (T12-L2)

201
Q

angle cut off bowlers angle

A

<20

202
Q

critical angle of gissane

A

normal-95-105

203
Q

lateral calcaneal fx compl

A

entrapment peroneal tendons

204
Q

what’s imp to consider w/ calcaneal fx?

A

subtalar joint involvement-fracture line through critical angle of gissane

205
Q

os peroneum

A

in peroneus longus

206
Q

zones jones fx

A

avulsion –> jones —> stress

207
Q

foot fracture in dancer

A

avulsion base 5th metatarsal

208
Q

jones distance cut off

A

-1.5 cm from tuberosity

209
Q

mx jones fx

A
  • cast

- may need int fixation via risk non-union

210
Q

5th metatarsal fx’s

A

1) avulsion via peroneus brevis or lateral cord plantar aponeurosis
2) jones-1.5 cm from tuberosity
3) stress-high risk!

211
Q

mc disloc of foot

A

lisfranc

212
Q

painful os peroneus syndrome (POPS)

A

stress rxn/pain related to os in peroneus LONGUS, ~10% population
-bf cuboid tunnel

213
Q

fleck sign

A
  • fx of 2nd MT ass w/ lisfranc injury.

- fragment is in Lisfranc space btw 1st and 2nd MT

214
Q

complications missed lisfranc injury

A
  • non union

- arthritis

215
Q

moa lisfranc injury

A

extreme plantar flexion

216
Q

master knot of henry

A

where dick crosses harry at medial ankle

217
Q

sinus tarsi syndrome

A

fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
+/- tears

218
Q

sinus tarsi syndrome

A
  • fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
  • +/- lig tears
  • ass: rheum, abN loading
219
Q

plantar fasciitis thickness cutoff

A

> 4mm (central band most involved)

220
Q

progression flat foot

A

PTT –> spring –> sinus tarsi jacked –> heel strike –> plantar fasciitis

221
Q

pain at heel, worse with dorsiflexion

A

plantar fasciitis

222
Q

split brevis ass

A

80% lateral lig injruy

223
Q

Morton’s neuroma-path, usual location

A
  • compression, entrap plantar digital n by intermetatarsal lig –> thickening perineural fibrosis.
  • NOT a neuroma. It’s a scar.
  • 3rd and 4th metatarsal heads (3rd intermetatarsal space)
224
Q

mulder’s sgx

A

squeeze foot –> Morton’s neuroma pops out on sono, pain+

225
Q

Morton’s neuroma vs inter metatarsal bursitis

A

neuroma=below plantar lig

-bursiti-extend above transverse lig and has dumbbell shape. <3mm (small)

226
Q

haglund’s syndrome/deformity aka Mulholland deformity

A
  • retroachilles bursitis
  • retrocalcaneal bursitis
  • distal achilles thickening
  • pst calcaneal bony pump bulb
227
Q

what’s a synchondrosis?

A

joint w/ no mvmt, lined with cartilage

228
Q

os trigonum syndrome

A

flexor hallus longus during extreme ankle flexion

“ballet dancer”

229
Q

achilles tendon tear vs xanthoma

A

Tear UL, weekend warrier, step 1: FQ abx

Xanthoma BL, cholesterol

230
Q

classic ass calcaneal tuberosity avulsion

A

DM

231
Q

achilles tendon tear distance cutoff

A

4 cm above calcaneal insertion

232
Q

plantaris rupture

A
  • “tennis leg”
  • accessory tendon in 10%, can rupture and mimic achilles (“still able to plantar flex”)
  • fluid btw soles and medial head gastric
  • ass w/ ACL tears
233
Q

avulsion medial press calcaneal tuberosity/bone spur

A

plantar fascia rupture

234
Q

dorsolateral ant calcaneus avulsion fracture

A

extensor digitorum brevis avulsion

235
Q

avulsion lateral to calcaneocuboid joint

A

calcaneocuboid ligament avulsion

236
Q

pst tibial tendon attachments

A

hits nav tuberosity –> medial cuneiform –> 2-4 metatarsals

237
Q

flexor hallucis longus tendon attachements

A

fib –> btw sesamoids –> base of great toe distal phalynx

238
Q

flexor digitorum longus attachments

A

tibia –> base of 2nd-5th distal phalanges

239
Q

spring ligament

A

calcaneonavicular ligs

240
Q

deltoid lig

A

ant & pst tibiotalar/tibiocalc/tibionav

241
Q

peroneus brevis distal att

A

base of 5th metatarsal

242
Q

peroneus longus distal att

A

medial cuneiform & 1st metatarsal

243
Q

normal coracoclavicular distance

A
  • 1-1.3 cm

- increased in ligamentous tears or AC joint injury

244
Q

origin and distal insertion of bicep brachii

A
  • long head supraglenoid tubercle of scapula
  • short head=coracoid
  • distal-radial tuberosity
245
Q

when should acromion oss center fuse? how often does it not? how often Is it BL?

A
  • by age 25 yo
  • 2-10% don’t
  • BL 60%-
246
Q

rotator cuff interval-boundaries and contents

A

SGHL, coracohumeral ligament, long head bicepss tendon

-space btw supraspinatus & subscapularis

247
Q

olecranon fossa

A
  • can be seen on AP and lat views

- poss site for loose bodies

248
Q

lacertus fibrosis

A

biceps aponeurosis conning bicep tendon to f overlying common flexor m’s.
-biceps tears should be described in relation to this.

249
Q

cubital tunnel

A

enclosed by arcuate ligament

250
Q

What is the only carpal bone with a tendon insertion? what att?

A

pisiform.

-FCU (then con’t as pisohamate and posometacarpal legs)

251
Q

Stenner lesion

A

adductor pollicis

252
Q

which quadrant of the hip labrum is MC injured?

A

anterosuperior

253
Q

normal ration of patella tendon to patella on lateral image/

A

1 +/- 20%, ie: 0.8- 1.2

254
Q

segond fracture=avulsion by what structure?

A

joint capsule

255
Q

shape of medial and lateral tibial plataeus?

A
  • medial: golf tee

- lateral: hockey puck

256
Q

Gerdy tubercle

A

insertion site of IT band (site of avulsion of IT band) on tibia

257
Q

knee transverse ligament

A

-connects 2 menisci ant

258
Q

syndesmotic tibiofibular clear space normal range

A

4-6 mm or <44% of fibular width

259
Q

chopart joint

A

talonavicular and calcaneocuboid joints

260
Q

pes anserinus

A

refers to the conjoined tendons of three muscles of the thigh. It inserts onto the anteromedial (front and inside) surface of the proximal tibia. The muscles are the sartorius, gracilis and semitendinosus sometimes referred to as the guy ropes.

261
Q

pseudo defect of capitellum

A

coronal img through pst nonarticular asp capitellum

262
Q

elbow pseudo loose body

A

Small piece of fat that you’ll see on the sagittal image, that looks like a small loose body or a cartilage defect.
This can be explained if we look at the articular surface of the olecranon.
Typically the olecranon has two pieces of cartilage with a small area inbetween, that fills with fat.

263
Q

elbow plica

A

Structure on the lateral side of the joint sometimes seen
It can be prominent and almost look like a meniscus.
It is a normal structure, but sometimes it is thickened or irregular and it may be a cause of symptoms.

264
Q

RC innervation

A
  • supra and infraspinatous-suprascapular n
  • subscap-subscap nerve
  • teres minor-axillary n
265
Q

anatomy ACL

A
  • 3-5 layers, AM & PL fbrs
  • anteromedial tib plateau/spine of medial meniscus –> pst medial lateral femoral condyle
  • intra-articular, extra synovial
266
Q

Rim rent tear

A

A rim rent tear of the rotator cuff, also known as partial articular surface tendon avulsion (PASTA), is a specific subtype of partial-thickness rotator cuff tear that involves the articular surface footprint at the site of tendon attachment into the greater tubercle 2. This sort of tear is relatively common and also can involve the infraspinatus tendon

radiology (31 decks)

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