msk trauma Flashcards
1
Q
2 stress fractures
A
1) fatigue
2) insufficiency
2
Q
tuft fx w/ disruption of nail plate-mx?
A
“open” but no OR, just abx
3
Q
phases of fracture healing
A
1) inflamm
2) reparative
3) remodeling
* gran tissue at 7-14 d = MORE LYTIC
4
Q
fracture healing-fastest, normal, slowest
A
- phalanges- 3 wks
- most-6-8 wks
- tibia-10 wks (slowest)
5
Q
abnormal healing
A
1) delayed-2x as long
2) non-union-will not heal without intervention. 6-9 mo
3) mal union
6
Q
classic locs for “non-union” fx
A
- scaphoid
- ant tibia
- lat femoral neck
7
Q
RFs for abnormal fracture healing
A
- vit D
- gastric bypass
- drugs/mx-smoking, nsaids, prednisone (steroids)
8
Q
stress fracture compressive vs tensile sides healing
A
compressive-pushed together, heal well
tensile- pulled apart, no bueno
9
Q
tibia compressive vs tensile side
A
- compressive=pst (MC), prox or distal 3rd
- tensile= ant mid shaft. “dreaded black lines”
10
Q
MC stress fx in young athlete
A
tibia
11
Q
femoral neck compressive vs tensile side
A
C=medial (MC), younger, inferior femoral neck
-T=lateral; oder people
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
13
Q
most fractured tarsal bone
A
calcaneus (75% intraairticular)
14
Q
orientation calcaneal stress fx
A
perpendicular
15
Q
which tarsal is at risk for AVN?
A
navicular
16
Q
march fracture
A
metatarsal stress fx seen in recruits marching all day
17
Q
stress fx to know…
A
- tibia (mc)
- calcaneus (perpendicular to trabeculae)
- navicular-risk AVN
- march fx= metatarsal (recruits marching all day)
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
19
Q
how do you know wrist xray is true lateral?
A
palmar cortex of pisiform centrally btw palmar cortex of scaphoid & capitate
20
Q
BF to scaphoid retrograde? why is it retrograde
A
- dorsal carpal branch of radial artery
- 80% covered by cartilage
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)
22
Q
1st sign avn
A
sclerosis
23
Q
mc scaphoid fx site.
A
waste
24
Q
prieser dx
A
atraumatic avn of scaphoid
25
Mx scaphoid fx displacement >1mm
fixation screw
26
perilunate dislocation ass injury
- 60% scaphoid fx
| - hutchinson/chauffeur fx
27
scapholunate ligament disruption-sign, distance, ass injuries
- 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
28
scapholunate ligament-parts, ass pathology
- volar, dorsal (MI for stability), middle
- ass radial/carpal fx
- DISI
- SLAC wrist
29
SLAC causes
- trauma
| - CPPD
30
scaphoid fracture compl/associated injuries
- 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.
31
normal scaphoid-lunate angle
30-60 degrees
32
DISI
dorsal intercalated segmental instability=-radial sided injury (scapholunate).
- dorsiflexion instability
- lunate comes free of stabilizing scaphoid and rocks dorsally
- widening of SL angle
33
VISI
volar intercalated segmental instability
- problem with lunotriquetral lig/ulnar side)
- lunate tilts volar --> SL angle <30˚
34
spectrum carpal dislocation severity
SL --> perilunate --> mid-carpal --> lunate (alphabetical)
35
humpback deformity
angulation prx & distal scaphoid fragments due to fracture at waste --> no-union, collapse
-ass w/ DISI
36
DISI ass
- scaphoid fx, humpback deformity
| - SNAC & SLAC
37
treatment SNAC/SLAC
- wrist fusion- strength; no mobility
| - prox row carpectomy-mobility, no strength
38
mid carpal dislocation ass injuries
- triquetro-lunate interosseous ligament disruption
| - triquetrium fx
39
lunate dislocation ass injuries
occurs with a dorsal radiolunate ligament injuries
40
carpal dislocated around lunate vulnerable zones theory
- lesser arc-purely lig injury
- greater arc-fx+ ("trans-scaphoid, perilunate dislocation")
- space of poirier-lig free (Poor), site of weakness
41
which synovial spaces in hand communicate and how it that demonstrated?
- pisiform recess & radiocarpal joint
1) fluid in pisiform recess okay in setting of RC eff
2) entry sites for wrist arthrography
42
GH joint and subacromial bursa
full thickness rotator cuff tear
43
ankle joint and common (lateral) perineal tendon sheath
calcaneofibular ligament tear
44
achilles tendon and pst subtalar joint
should not communicate.
45
DRUJ
distal radioulnar joint
46
1˚ stabilizer & shock absorber of DRUJ
triangular fibrocartilage complex (TFCC)
47
TFCC 5 components
1) triangular fibrocartilage-articular disc
2) volar & dorsal radioulnar ligaments
3) meniscus homologue
4) ULC
5) tendon sheet of UCL
48
TFCC injuries
```
class I-acute (fall on extended wrist)
class II-chronic/degenerative
*ulnar side more likely to heal
```
49
tfcc class II injury association
positive ulnar variance, ulnar impaction, central perforation, lunate abutment (cystic change)
50
ulnar positive and negative variance ass
(+)-ulnar impaction syndrome
| (-)-kienbock
51
ulnar impaction syndrome/ulnar abutment
ulnar --< lunate --> cystic change + TFCC tears
52
next step colles fx old man
DEXA
53
colles fx ass injury
ulnar styloid 50%
54
wrist fractures to know & high yield
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
55
radial tilt
volar, 11˚
56
extensor pollicis longus rupture
3wk-3mo post distal radial fx via irreg Lister's/dorsal radial tubercle
*MC in non-displaced fx
57
6 wrist extensor compartments
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
58
carpal tunnel contents
-4 flexor D profundus
-4 flexor D superficialis
-1 median nerve
-1 flexor pollicis longus
NOT: FCR, FCU, FPB, palmaris (if you have 1)
59
carpal tunnel syndrome expected findings
- BL n enlargement, increased signal, smashed/flattened
- "bowing of flexor retinaculum
- median n paresthesia (thumb --> radial 4th phalynx)
- thenar atrophy
60
carpal tunnel associations
-dialysis, pregnant, DM, hypoTh
61
Guyon's canal
pisiform and hamate
62
guyon canal syndrome
ulnar n
| -money bars & hook of hamate
63
sub-sheath tear/dislocation-what, dir of disloc
- extensor capi ulnari MEDIAL disloc from normal groove
| - implies rupture of overlying sheath
64
vaughan-jackson syndrom
sequential extensor tendon ruptures ulnar --> radial starting at compartment 5 (EDM)
-seen with worsening RA
65
things to think of on MRI wrist
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))
66
wrist tenosynovitis
diffuse (Tb or non MB, RA)
focal-infection, overuse
overuse=de quervain's, intersection, drummers
67
Tb/non TB myobacterium wrist tenosynovitis
- hand/wrist MC tendons
- spares m
- rice bodies
68
RA wrist tenosynovitis
* diffuse, early (bf bone!)
1) multiple flexor tendons
2) isolated extensor carpi ulnaris (comp 6)
3) vaughan jackson
69
intersection syndrome
- rowers
| - 1st comp intersects the 2nd --> extensor carpi radialis breves & long tenosynovitis
70
drummers wrist
3rd compartment (EPL)
71
wrist tenosynovitis focal infection
- surgical emergency if flexor tendon
| - myocbacterium marinum
72
Bennett & rolando
base of 1st metacarpal
73
tendon involved in Bennett fracture dorsolateral dislocation
abductor pollicis longus
74
gamekeeper/skiers thumb
- base of 1st proximal phalanx
- ulnar collateral ligament disruption
- stener lesion
75
stener
- adductor tendon aponeurosis caught in torn edge of UCL in a gamekeeper/skier's thumb
- yo yo on MRI
- sx (for lig healing)
76
trigger finger/stenosis tenosynovitis
- over use flexor tendon --> thickening of sheath
| - equivalent to os trigonometry syndrome of ankle
77
forearm fx eponyms
- 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
78
accessory aconeus/aconeus epitrochlearis.
-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.
79
aconeus
?accessory m usually on lateral elbow
80
lateral epicondylitis
- tennis.
- varus stress
- extensor carpi radialis brevis & RCL
81
medial epicondylitis
- golf
- valgus stress
- common flexor tendon, ulnar nerve
82
which is more common? lateral or medial epicondylitis?
lateral
83
partial ulnar collateral ligament tear
- throwers via valgus stress
| - anterior bundle w/ contrast tracking medial to tubercle--> T-sign
84
things to think about with elbow MRI
- 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
85
UCL attachment
-medial coronoid sublime tubercle
86
little leaguer elbow
-chronic valgus stress --> medial eippcondyle injury (fx, delayed closure, etc)
87
valgus overload syndrome
- adult throwers
- lateral compression, medial tension, pst sheer--> triad:
1) UCL injury
2) pst humerus/ulna arthritis
3) capitellum OCD
88
dialysis elbow
olecranon bursitis
89
bicep injury related to what n injury
median
90
tricep rupture
- rare (least common in body)
| - SH II fx of olecranon
91
elbow dislocation
- 2nd MC
- radial head & coronoid process
- "tear LUCL --> partial dislocation (coronoid perched on tracheal) --> total w/ UCL tear
92
total shoulder arthroplasty complications
1) loosening glenoid component-MC
2) anterior escape-ant migration HH after subscapularis fx
3) pst acromion fx (deltoid tugging)
93
subacromial impingement
- mc.
- supraspinatus tendon
1) OP
2) coracoacromial lig thickening
94
subcoracoid impingement
coracoid & lesser tub decreased dist --> subscap
| -cong or post traumatic
95
hooked acromion
type III
96
internal RC impingement
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
97
RC tear sides
articular > bursal
98
critical zone supraspinatus tear
1-2 cm from tendon footprint. MC
| -also mc HADD/calcific tendinitis
99
"massive rotator cuff tear"
-2/4 RC m's
100
how do you know you have full thickness tear?
gad in bursa
101
rotator cuff interval
spot with bicep tendon btw supra spinouts and subscap
102
multi-directional GH instability
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)
103
adhesive capsulitis/frozen shoulder
- loss of fat in RC interval, thickened axillary fold
- GH volume decrease w/ injunction
- thickened pstinf capsule
- enhancement of rotator cuff interval
104
SLAP mimics
sublabral recess
sublabral foramen
Buford complex
105
how does management change with type 4 SLAP?
extends into bicep anchor (type 4): debridement + biceps tenodesis (vs just debridement)
106
SLAP tears-what, who
- tear of superior labrum along AP dir that involves labrum at insertion of long head biceps
- swimmers (overhead)
- >40 --> ass RC tear
107
buford complex ass finding
thickened middle GH lig
108
bankart lesions
GLAD-mildest
Perthes-periosteum intact
ALPSA-periosteum intact
Bankart (osseous, cartilage)
109
labrum tears not ass w/ instability
- SLAP
| - GLAD
110
pst GH instability
- 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
Kim's lesion
- incompletely avulsed/flattened/mashed pst inf GH labrum
| - testable: glenoid cartilage & pst labrum relationship preserved
112
HAGL
- "humeral avulsion GH ligament"
- ant shoulder disloc
- inferior lig
- J sgx (vs normal U shaped inf GH recess)
113
subluxation biceps tendon
-medial dislocation long head via transverse lig disruption ISO subscap tear
114
cyst at suprascapular notch
hits nerve to both supraspinatus and infraspinatus
115
cyst at spinoglenoid notch
hits nerve to infraspinatus
116
quadrilateral space borders & syndrome
- borders: teres minor above, major below, hum neck lateral, triceps medial
- ax n compression from fibrotic bands --> teres minor atrophy
117
personage turner syndrome
idiopathic involvement of brachial plexus
118
RC tendon to attach (partially) to lesser tub?
subscap (also att to GT)
119
general anatomy deltoid org and insertion
- org: 3 heads-clavicle, acromion, lateral 2/3 scapular spine
- insert: deltoid tuberosity of humerus
120
femoral shaft fx etiology
medial= stress fx (medial=management)
| lateral=bisphos. cortical thickening
121
"foot in internal rotation"
pst dislocation hip (against dashboard)
122
ant and pst columns acetabulum
IP & II lines forming upside down Y
123
both column acetabular fracture problem
divides ilium prox to hip joint --> no articular surface of hip attached to axial skull
124
corona mortis
anastomosis inf epigastric & obturator
125
hip fracture most at risk of avn
displaced intracapsular
| *degree of displacement (+) risk of avn
126
isolated avulsion lesser trochanter
pathologic
127
avulsion fx pelvis
1) iliac-abd
2) ASIS-satorius
3) AIIS-RA
4) GT-glute
5) LT-iliopsoas
6) ischium-hamstring
7) pubic symph- adductor
128
IT band syndrome
fluid on both sides
129
snapping hip syndrome types & w/u algorithm
-ext, int, intraart
130
hip labral tears
- anterosuper
| - cysts
131
largest bursa of body
iliopsoas. communicates w/ joint 15%
132
iliopsoas bursitis
fluid mass ant to hip/femur
133
CAM FAI
- men
| - bony on femur H/N
134
knee lateral tendon complex
- IT (insert on Gurdy's tubercle of tibia)
- bicep femoris (insert on fib)
- LCL (insert on fib)
135
femoroacetabular impingement
painful hip mvmt via femoral and acetabular deformities ?--> degen?
136
pincer type FAI
- young female athlete
- pst acetabulum cross over ant
- BW's: coxa profunda, protrusion, ischial spine sign
137
key component of pincer type FAI eval?
-coccyx must be centered at PS
138
coxa profunda
acetabulum med to II line
139
acetabular protrusion
femur medial to II line
140
prominent ischial spine
triangular prj ischial spine medial to pelvic inset/IP line
141
cross over sign
pst lip acetabulum (usually lateral) crosses over ant lip
142
Classic FAI associations
Os acetabuli (40%)
Labral tears
early arthritis
143
Os acetabuli-what, testable associations
- unfused 2˚ ossification center
| - ass: FAI, labral tears
144
total hip arthroplasty complications
1)
145
"Wolff's law"
- 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
asyx complications of hip arthroplasty
- stress shielding
- aggressive granulomatosis
- heterotopic ossification
147
mc complaint hetertopic ossification s/p hip arthroplasty
hip stiffness
148
mx before THA in ank sponk pts
low dose pox radiation bc so prone to heterotypic ossification
149
creep
thinning of acetabular cup in dir of wt bearing (along fem neck towards spine), ie: medial (vs polyethylene cup wear)
150
polyethylene cup abnormal wear
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
MC indication THA revision
aseptic loosening
152
aseptic loosening xray cut off
>2mm or migration (varus tilt of femoral stem)
153
subsidence
* 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
particle disease aka
aggressive granulomatosis
- wear --> inflamm --> lytic (smooth) & JE.
- areas of wear & screws
- late (~1-5 yrs)
155
particle disease vs infection
- SMOOTH
| - no esr, crp
156
app sacral insufficiency fracture on xray
occult
157
causes sacral insufficiency fracture
- OP (mc)
| - Renal fx, RA, radiation, THA mech change
158
mechanism segond fx
internal rotation & varus stress --> avulsion lateral tibial plateau at att of lateral collateral band
159
reverse segond fx
- medial tib plateau ass w/ PCL
| - ext rot
160
arcuate sgx
avulsion prox fibula at insertion arcuate ligament
| PCL
161
deep intercondylar notch sgx
depression lateral femoral condyle (terminal sulcus) occurring 2/2 impaction injury via ACL insuff/tear
162
which knee ligs are susceptible to magic angle artifact?
PCL, patellar tendons
163
magic angle phenomenon
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
ACL associated injuries
1) lateral tibial plateau and tib spine fx
2) O'donoghue's unhappy triad
3) kissing contusion, intercondylar notch
4) ant drawer sgx
165
ACL associated injuries
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
BW: celery stalk
T2/STIR app of acl mucoid degeneration
167
BW: drumstick
T1 app of ACL mucoid degen
168
pts with all mucoid degen are predisposed to...
ganglion cysts
169
ACL repair: femoral and tibial tunnels
- Tibial-should parallel and be pst to blumensaat line. Determines impingement.
- Femoral tunnel-length and tension. Determines isometry.
170
tibial tunnel-too steep, flat or ant
- steep: impinged by femur on ext
- flat-too lax, no stability
- ant: pinching at anterior inferior intercondylar roof. "roof impingement"
171
complications of acl repair
- malpositioning
- arthrofibrosis (16wks)
- graft tear-flat angle, 4-8 mo
172
arthrofibrosis s/p acl repair
- diffuse
- focal (mc, cyclops). low sign ball in Hoffa's fat pad
- "palpable audible clunk"
173
acl graft tear
4-8 mo post op
- flat angle
- T2 sign ++
- fbr discon't
- uncovering pst horn lat meniscus (2˚)
- ant tib translation (2˚)
174
Posterior lateral corner-contents, img of tear, sign
- IT band, biceps femurs, LCL ,popliteus tenton
- edema in fib head
- failure of ACL graft
175
pcl tear-app, next step
- stretched, thick (>7mm)
| - popliteal flow void
176
radial tear signs
- truncated triangle
- cleft (most reliable)
- ghost/absent triangle
177
flap tear (parrot beak)
radial tear charing dir into long dir
178
bakers cyst
btw semi membranous and medial head gastroc tendons
179
bucket handle tear signs
- "double PCL"
| - not enough bow ties
180
discoid meniscus app
- coronal: ext into notch
| - sag-3 consecutive bow ties
181
discoid complications
meniscal tear
182
"pediatric pt with meniscal tear"
discoid
183
discoid meniscus loc and types
- lateral
| - wrisberg variant most prone to injury
184
meniscocapasular separation
capsular lig of MCL complex deepest and weakest --> sep of meniscus and MCL
1) MLC tears
2) surgical EM
185
meniscal ossicle
ossification of pst horn med men 2/2 trauma or dev
| *radial root tear
186
meniscofemoral ligaments
Wrisberg (in the back)
- H ant
- mimics of tears
187
meniscal flounce
ruffled meniscus not ass w/ tears but looks like one
188
patella disloc
- lat
- contusion: lat fem condyle & medial patella
- MPFL tear
- "trochlear dysplasia"-trochlea too flat
189
patella alta classic ass
SLE, elderly, trauma, athletes, RA
190
bw: "BL patellar rupture"
chronic steroids
191
fat impingement syndrome of knee
T2+ Hoffa's fat inf to patella
192
class tib plateau fx
schatzker
| -2 MC (split and depressed lateral plateau)
193
pilon fx (tibial plafond)
talus impacts into tib --> comm, intrart distal tib fx + distal fib (95%)
194
slowest healing bone in body
tib (also mc long bone fx)
195
SH type: tillaux fx
- 3
- veritcal (medial epiph) --> horz (physics)
- med--> lat
196
SH type: triplane fx
4
197
direction of fox's in triplane fx
vert epiph
horz physics
oblique metaph
198
Maisonneuve fx
| Monteggia fx
```
Masonneuve= LE
Monteggia = UE
```
199
Maisonneuve fx -what, mech, sgx's, next step
- 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
next step: Casanova fx
img spine (T12-L2)
201
angle cut off bowlers angle
<20
202
critical angle of gissane
normal-95-105
203
lateral calcaneal fx compl
entrapment peroneal tendons
204
what's imp to consider w/ calcaneal fx?
subtalar joint involvement-fracture line through critical angle of gissane
205
os peroneum
in peroneus longus
206
zones jones fx
avulsion --> jones ---> stress
207
foot fracture in dancer
avulsion base 5th metatarsal
208
jones distance cut off
-1.5 cm from tuberosity
209
mx jones fx
- cast
| - may need int fixation via risk non-union
210
5th metatarsal fx's
1) avulsion via peroneus brevis or lateral cord plantar aponeurosis
2) jones-1.5 cm from tuberosity
3) stress-high risk!
211
mc disloc of foot
lisfranc
212
painful os peroneus syndrome (POPS)
stress rxn/pain related to os in peroneus LONGUS, ~10% population
-bf cuboid tunnel
213
fleck sign
- fx of 2nd MT ass w/ lisfranc injury.
| - fragment is in Lisfranc space btw 1st and 2nd MT
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complications missed lisfranc injury
- non union
| - arthritis
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moa lisfranc injury
extreme plantar flexion
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master knot of henry
where dick crosses harry at medial ankle
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sinus tarsi syndrome
fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
+/- tears
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sinus tarsi syndrome
- fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
- +/- lig tears
- ass: rheum, abN loading
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plantar fasciitis thickness cutoff
>4mm (central band most involved)
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progression flat foot
PTT --> spring --> sinus tarsi jacked --> heel strike --> plantar fasciitis
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pain at heel, worse with dorsiflexion
plantar fasciitis
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split brevis ass
80% lateral lig injruy
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Morton's neuroma-path, usual location
- 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)
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mulder's sgx
squeeze foot --> Morton's neuroma pops out on sono, pain+
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Morton's neuroma vs inter metatarsal bursitis
neuroma=below plantar lig
| -bursiti-extend above transverse lig and has dumbbell shape. <3mm (small)
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haglund's syndrome/deformity aka Mulholland deformity
- retroachilles bursitis
- retrocalcaneal bursitis
- distal achilles thickening
- pst calcaneal bony pump bulb
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what's a synchondrosis?
joint w/ no mvmt, lined with cartilage
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os trigonum syndrome
flexor hallus longus during extreme ankle flexion
| "ballet dancer"
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achilles tendon tear vs xanthoma
Tear UL, weekend warrier, step 1: FQ abx
| Xanthoma BL, cholesterol
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classic ass calcaneal tuberosity avulsion
DM
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achilles tendon tear distance cutoff
4 cm above calcaneal insertion
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plantaris rupture
- "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
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avulsion medial press calcaneal tuberosity/bone spur
plantar fascia rupture
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dorsolateral ant calcaneus avulsion fracture
extensor digitorum brevis avulsion
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avulsion lateral to calcaneocuboid joint
calcaneocuboid ligament avulsion
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pst tibial tendon attachments
hits nav tuberosity --> medial cuneiform --> 2-4 metatarsals
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flexor hallucis longus tendon attachements
fib --> btw sesamoids --> base of great toe distal phalynx
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flexor digitorum longus attachments
tibia --> base of 2nd-5th distal phalanges
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spring ligament
calcaneonavicular ligs
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deltoid lig
ant & pst tibiotalar/tibiocalc/tibionav
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peroneus brevis distal att
base of 5th metatarsal
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peroneus longus distal att
medial cuneiform & 1st metatarsal
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normal coracoclavicular distance
- 1-1.3 cm
| - increased in ligamentous tears or AC joint injury
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origin and distal insertion of bicep brachii
- long head supraglenoid tubercle of scapula
- short head=coracoid
- distal-radial tuberosity
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when should acromion oss center fuse? how often does it not? how often Is it BL?
- by age 25 yo
- 2-10% don't
- BL 60%-
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rotator cuff interval-boundaries and contents
SGHL, coracohumeral ligament, long head bicepss tendon
| -space btw supraspinatus & subscapularis
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olecranon fossa
- can be seen on AP and lat views
| - poss site for loose bodies
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lacertus fibrosis
biceps aponeurosis conning bicep tendon to f overlying common flexor m's.
-biceps tears should be described in relation to this.
249
cubital tunnel
enclosed by arcuate ligament
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What is the only carpal bone with a tendon insertion? what att?
pisiform.
| -FCU (then con't as pisohamate and posometacarpal legs)
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Stenner lesion
adductor pollicis
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which quadrant of the hip labrum is MC injured?
anterosuperior
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normal ration of patella tendon to patella on lateral image/
1 +/- 20%, ie: 0.8- 1.2
254
segond fracture=avulsion by what structure?
joint capsule
255
shape of medial and lateral tibial plataeus?
- medial: golf tee
| - lateral: hockey puck
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Gerdy tubercle
insertion site of IT band (site of avulsion of IT band) on tibia
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knee transverse ligament
-connects 2 menisci ant
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syndesmotic tibiofibular clear space normal range
4-6 mm or <44% of fibular width
259
chopart joint
talonavicular and calcaneocuboid joints
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pes anserinus
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.
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pseudo defect of capitellum
coronal img through pst nonarticular asp capitellum
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elbow pseudo loose body
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.
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elbow plica
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.
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RC innervation
- supra and infraspinatous-suprascapular n
- subscap-subscap nerve
- teres minor-axillary n
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anatomy ACL
- 3-5 layers, AM & PL fbrs
- anteromedial tib plateau/spine of medial meniscus --> pst medial lateral femoral condyle
- intra-articular, extra synovial
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Rim rent tear
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
