msk trauma Flashcards
2 stress fractures
1) fatigue
2) insufficiency
tuft fx w/ disruption of nail plate-mx?
“open” but no OR, just abx
phases of fracture healing
1) inflamm
2) reparative
3) remodeling
* gran tissue at 7-14 d = MORE LYTIC
fracture healing-fastest, normal, slowest
- phalanges- 3 wks
- most-6-8 wks
- tibia-10 wks (slowest)
abnormal healing
1) delayed-2x as long
2) non-union-will not heal without intervention. 6-9 mo
3) mal union
classic locs for “non-union” fx
- scaphoid
- ant tibia
- lat femoral neck
RFs for abnormal fracture healing
- vit D
- gastric bypass
- drugs/mx-smoking, nsaids, prednisone (steroids)
stress fracture compressive vs tensile sides healing
compressive-pushed together, heal well
tensile- pulled apart, no bueno
tibia compressive vs tensile side
- compressive=pst (MC), prox or distal 3rd
- tensile= ant mid shaft. “dreaded black lines”
MC stress fx in young athlete
tibia
femoral neck compressive vs tensile side
C=medial (MC), younger, inferior femoral neck
-T=lateral; oder people
SONK-what, who, where
“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
most fractured tarsal bone
calcaneus (75% intraairticular)
orientation calcaneal stress fx
perpendicular
which tarsal is at risk for AVN?
navicular
march fracture
metatarsal stress fx seen in recruits marching all day
stress fx to know…
- tibia (mc)
- calcaneus (perpendicular to trabeculae)
- navicular-risk AVN
- march fx= metatarsal (recruits marching all day)
high vs low risk stress fx based on healing
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
how do you know wrist xray is true lateral?
palmar cortex of pisiform centrally btw palmar cortex of scaphoid & capitate
BF to scaphoid retrograde? why is it retrograde
- dorsal carpal branch of radial artery
- 80% covered by cartilage
which age group most susc to scaphoid fx age group
-adol/young adults (grandma more likely to get distal radial fx with similar mechanism)
1st sign avn
sclerosis
mc scaphoid fx site.
waste
prieser dx
atraumatic avn of scaphoid
Mx scaphoid fx displacement >1mm
fixation screw
perilunate dislocation ass injury
- 60% scaphoid fx
- hutchinson/chauffeur fx
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
scapholunate ligament-parts, ass pathology
- volar, dorsal (MI for stability), middle
- ass radial/carpal fx
- DISI
- SLAC wrist
SLAC causes
- trauma
- CPPD
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.
normal scaphoid-lunate angle
30-60 degrees
DISI
dorsal intercalated segmental instability=-radial sided injury (scapholunate).
- dorsiflexion instability
- lunate comes free of stabilizing scaphoid and rocks dorsally
- widening of SL angle
VISI
volar intercalated segmental instability
- problem with lunotriquetral lig/ulnar side)
- lunate tilts volar –> SL angle <30˚
spectrum carpal dislocation severity
SL –> perilunate –> mid-carpal –> lunate (alphabetical)
humpback deformity
angulation prx & distal scaphoid fragments due to fracture at waste –> no-union, collapse
-ass w/ DISI
DISI ass
- scaphoid fx, humpback deformity
- SNAC & SLAC
treatment SNAC/SLAC
- wrist fusion- strength; no mobility
- prox row carpectomy-mobility, no strength
mid carpal dislocation ass injuries
- triquetro-lunate interosseous ligament disruption
- triquetrium fx
lunate dislocation ass injuries
occurs with a dorsal radiolunate ligament injuries
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
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
GH joint and subacromial bursa
full thickness rotator cuff tear
ankle joint and common (lateral) perineal tendon sheath
calcaneofibular ligament tear
achilles tendon and pst subtalar joint
should not communicate.
DRUJ
distal radioulnar joint
1˚stabilizer & shock absorber of DRUJ
triangular fibrocartilage complex (TFCC)
TFCC 5 components
1) triangular fibrocartilage-articular disc
2) volar & dorsal radioulnar ligaments
3) meniscus homologue
4) ULC
5) tendon sheet of UCL
TFCC injuries
class I-acute (fall on extended wrist) class II-chronic/degenerative *ulnar side more likely to heal
tfcc class II injury association
positive ulnar variance, ulnar impaction, central perforation, lunate abutment (cystic change)
ulnar positive and negative variance ass
(+)-ulnar impaction syndrome
(-)-kienbock
ulnar impaction syndrome/ulnar abutment
ulnar –< lunate –> cystic change + TFCC tears
next step colles fx old man
DEXA
colles fx ass injury
ulnar styloid 50%
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
radial tilt
volar, 11˚
extensor pollicis longus rupture
3wk-3mo post distal radial fx via irreg Lister’s/dorsal radial tubercle
*MC in non-displaced fx
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
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)
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
carpal tunnel associations
-dialysis, pregnant, DM, hypoTh
Guyon’s canal
pisiform and hamate
guyon canal syndrome
ulnar n
-money bars & hook of hamate
sub-sheath tear/dislocation-what, dir of disloc
- extensor capi ulnari MEDIAL disloc from normal groove
- implies rupture of overlying sheath
vaughan-jackson syndrom
sequential extensor tendon ruptures ulnar –> radial starting at compartment 5 (EDM)
-seen with worsening RA
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))
wrist tenosynovitis
diffuse (Tb or non MB, RA)
focal-infection, overuse
overuse=de quervain’s, intersection, drummers
Tb/non TB myobacterium wrist tenosynovitis
- hand/wrist MC tendons
- spares m
- rice bodies
RA wrist tenosynovitis
- diffuse, early (bf bone!)
1) multiple flexor tendons
2) isolated extensor carpi ulnaris (comp 6)
3) vaughan jackson
intersection syndrome
- rowers
- 1st comp intersects the 2nd –> extensor carpi radialis breves & long tenosynovitis
drummers wrist
3rd compartment (EPL)
wrist tenosynovitis focal infection
- surgical emergency if flexor tendon
- myocbacterium marinum
Bennett & rolando
base of 1st metacarpal
tendon involved in Bennett fracture dorsolateral dislocation
abductor pollicis longus
gamekeeper/skiers thumb
- base of 1st proximal phalanx
- ulnar collateral ligament disruption
- stener lesion
stener
- adductor tendon aponeurosis caught in torn edge of UCL in a gamekeeper/skier’s thumb
- yo yo on MRI
- sx (for lig healing)
trigger finger/stenosis tenosynovitis
- over use flexor tendon –> thickening of sheath
- equivalent to os trigonometry syndrome of ankle
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
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.
aconeus
?accessory m usually on lateral elbow
lateral epicondylitis
- tennis.
- varus stress
- extensor carpi radialis brevis & RCL
medial epicondylitis
- golf
- valgus stress
- common flexor tendon, ulnar nerve
which is more common? lateral or medial epicondylitis?
lateral
partial ulnar collateral ligament tear
- throwers via valgus stress
- anterior bundle w/ contrast tracking medial to tubercle–> T-sign
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
UCL attachment
-medial coronoid sublime tubercle
little leaguer elbow
-chronic valgus stress –> medial eippcondyle injury (fx, delayed closure, etc)
valgus overload syndrome
- adult throwers
- lateral compression, medial tension, pst sheer–> triad:
1) UCL injury
2) pst humerus/ulna arthritis
3) capitellum OCD
dialysis elbow
olecranon bursitis
bicep injury related to what n injury
median
tricep rupture
- rare (least common in body)
- SH II fx of olecranon
elbow dislocation
- 2nd MC
- radial head & coronoid process
- “tear LUCL –> partial dislocation (coronoid perched on tracheal) –> total w/ UCL tear
total shoulder arthroplasty complications
1) loosening glenoid component-MC
2) anterior escape-ant migration HH after subscapularis fx
3) pst acromion fx (deltoid tugging)
subacromial impingement
- mc.
- supraspinatus tendon
1) OP
2) coracoacromial lig thickening
subcoracoid impingement
coracoid & lesser tub decreased dist –> subscap
-cong or post traumatic
hooked acromion
type III
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
RC tear sides
articular > bursal
critical zone supraspinatus tear
1-2 cm from tendon footprint. MC
-also mc HADD/calcific tendinitis
“massive rotator cuff tear”
-2/4 RC m’s
how do you know you have full thickness tear?
gad in bursa
rotator cuff interval
spot with bicep tendon btw supra spinouts and subscap
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)
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
SLAP mimics
sublabral recess
sublabral foramen
Buford complex
how does management change with type 4 SLAP?
extends into bicep anchor (type 4): debridement + biceps tenodesis (vs just debridement)
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
buford complex ass finding
thickened middle GH lig
bankart lesions
GLAD-mildest
Perthes-periosteum intact
ALPSA-periosteum intact
Bankart (osseous, cartilage)
labrum tears not ass w/ instability
- SLAP
- GLAD
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
Kim’s lesion
- incompletely avulsed/flattened/mashed pst inf GH labrum
- testable: glenoid cartilage & pst labrum relationship preserved
HAGL
- “humeral avulsion GH ligament”
- ant shoulder disloc
- inferior lig
- J sgx (vs normal U shaped inf GH recess)
subluxation biceps tendon
-medial dislocation long head via transverse lig disruption ISO subscap tear
cyst at suprascapular notch
hits nerve to both supraspinatus and infraspinatus
cyst at spinoglenoid notch
hits nerve to infraspinatus
quadrilateral space borders & syndrome
- borders: teres minor above, major below, hum neck lateral, triceps medial
- ax n compression from fibrotic bands –> teres minor atrophy
personage turner syndrome
idiopathic involvement of brachial plexus
RC tendon to attach (partially) to lesser tub?
subscap (also att to GT)
general anatomy deltoid org and insertion
- org: 3 heads-clavicle, acromion, lateral 2/3 scapular spine
- insert: deltoid tuberosity of humerus
femoral shaft fx etiology
medial= stress fx (medial=management)
lateral=bisphos. cortical thickening
“foot in internal rotation”
pst dislocation hip (against dashboard)
ant and pst columns acetabulum
IP & II lines forming upside down Y
both column acetabular fracture problem
divides ilium prox to hip joint –> no articular surface of hip attached to axial skull
corona mortis
anastomosis inf epigastric & obturator
hip fracture most at risk of avn
displaced intracapsular
*degree of displacement (+) risk of avn
isolated avulsion lesser trochanter
pathologic
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
IT band syndrome
fluid on both sides
snapping hip syndrome types & w/u algorithm
-ext, int, intraart
hip labral tears
- anterosuper
- cysts
largest bursa of body
iliopsoas. communicates w/ joint 15%
iliopsoas bursitis
fluid mass ant to hip/femur
CAM FAI
- men
- bony on femur H/N
knee lateral tendon complex
- IT (insert on Gurdy’s tubercle of tibia)
- bicep femoris (insert on fib)
- LCL (insert on fib)
femoroacetabular impingement
painful hip mvmt via femoral and acetabular deformities ?–> degen?
pincer type FAI
- young female athlete
- pst acetabulum cross over ant
- BW’s: coxa profunda, protrusion, ischial spine sign
key component of pincer type FAI eval?
-coccyx must be centered at PS
coxa profunda
acetabulum med to II line
acetabular protrusion
femur medial to II line
prominent ischial spine
triangular prj ischial spine medial to pelvic inset/IP line
cross over sign
pst lip acetabulum (usually lateral) crosses over ant lip
Classic FAI associations
Os acetabuli (40%)
Labral tears
early arthritis
Os acetabuli-what, testable associations
- unfused 2˚ ossification center
- ass: FAI, labral tears
total hip arthroplasty complications
1)
“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.
asyx complications of hip arthroplasty
- stress shielding
- aggressive granulomatosis
- heterotopic ossification
mc complaint hetertopic ossification s/p hip arthroplasty
hip stiffness
mx before THA in ank sponk pts
low dose pox radiation bc so prone to heterotypic ossification
creep
thinning of acetabular cup in dir of wt bearing (along fem neck towards spine), ie: medial (vs polyethylene cup wear)
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.
MC indication THA revision
aseptic loosening
aseptic loosening xray cut off
> 2mm or migration (varus tilt of femoral stem)
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
particle disease aka
aggressive granulomatosis
- wear –> inflamm –> lytic (smooth) & JE.
- areas of wear & screws
- late (~1-5 yrs)
particle disease vs infection
- SMOOTH
- no esr, crp
app sacral insufficiency fracture on xray
occult
causes sacral insufficiency fracture
- OP (mc)
- Renal fx, RA, radiation, THA mech change
mechanism segond fx
internal rotation & varus stress –> avulsion lateral tibial plateau at att of lateral collateral band
reverse segond fx
- medial tib plateau ass w/ PCL
- ext rot
arcuate sgx
avulsion prox fibula at insertion arcuate ligament
PCL
deep intercondylar notch sgx
depression lateral femoral condyle (terminal sulcus) occurring 2/2 impaction injury via ACL insuff/tear
which knee ligs are susceptible to magic angle artifact?
PCL, patellar tendons
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)
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
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
BW: celery stalk
T2/STIR app of acl mucoid degeneration
BW: drumstick
T1 app of ACL mucoid degen
pts with all mucoid degen are predisposed to…
ganglion cysts
ACL repair: femoral and tibial tunnels
- Tibial-should parallel and be pst to blumensaat line. Determines impingement.
- Femoral tunnel-length and tension. Determines isometry.
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”
complications of acl repair
- malpositioning
- arthrofibrosis (16wks)
- graft tear-flat angle, 4-8 mo
arthrofibrosis s/p acl repair
- diffuse
- focal (mc, cyclops). low sign ball in Hoffa’s fat pad
- “palpable audible clunk”
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˚)
Posterior lateral corner-contents, img of tear, sign
- IT band, biceps femurs, LCL ,popliteus tenton
- edema in fib head
- failure of ACL graft
pcl tear-app, next step
- stretched, thick (>7mm)
- popliteal flow void
radial tear signs
- truncated triangle
- cleft (most reliable)
- ghost/absent triangle
flap tear (parrot beak)
radial tear charing dir into long dir
bakers cyst
btw semi membranous and medial head gastroc tendons
bucket handle tear signs
- “double PCL”
- not enough bow ties
discoid meniscus app
- coronal: ext into notch
- sag-3 consecutive bow ties
discoid complications
meniscal tear
“pediatric pt with meniscal tear”
discoid
discoid meniscus loc and types
- lateral
- wrisberg variant most prone to injury
meniscocapasular separation
capsular lig of MCL complex deepest and weakest –> sep of meniscus and MCL
1) MLC tears
2) surgical EM
meniscal ossicle
ossification of pst horn med men 2/2 trauma or dev
*radial root tear
meniscofemoral ligaments
Wrisberg (in the back)
- H ant
- mimics of tears
meniscal flounce
ruffled meniscus not ass w/ tears but looks like one
patella disloc
- lat
- contusion: lat fem condyle & medial patella
- MPFL tear
- “trochlear dysplasia”-trochlea too flat
patella alta classic ass
SLE, elderly, trauma, athletes, RA
bw: “BL patellar rupture”
chronic steroids
fat impingement syndrome of knee
T2+ Hoffa’s fat inf to patella
class tib plateau fx
schatzker
-2 MC (split and depressed lateral plateau)
pilon fx (tibial plafond)
talus impacts into tib –> comm, intrart distal tib fx + distal fib (95%)
slowest healing bone in body
tib (also mc long bone fx)
SH type: tillaux fx
- 3
- veritcal (medial epiph) –> horz (physics)
- med–> lat
SH type: triplane fx
4
direction of fox’s in triplane fx
vert epiph
horz physics
oblique metaph
Maisonneuve fx
Monteggia fx
Masonneuve= LE Monteggia = UE
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
next step: Casanova fx
img spine (T12-L2)
angle cut off bowlers angle
<20
critical angle of gissane
normal-95-105
lateral calcaneal fx compl
entrapment peroneal tendons
what’s imp to consider w/ calcaneal fx?
subtalar joint involvement-fracture line through critical angle of gissane
os peroneum
in peroneus longus
zones jones fx
avulsion –> jones —> stress
foot fracture in dancer
avulsion base 5th metatarsal
jones distance cut off
-1.5 cm from tuberosity
mx jones fx
- cast
- may need int fixation via risk non-union
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!
mc disloc of foot
lisfranc
painful os peroneus syndrome (POPS)
stress rxn/pain related to os in peroneus LONGUS, ~10% population
-bf cuboid tunnel
fleck sign
- fx of 2nd MT ass w/ lisfranc injury.
- fragment is in Lisfranc space btw 1st and 2nd MT
complications missed lisfranc injury
- non union
- arthritis
moa lisfranc injury
extreme plantar flexion
master knot of henry
where dick crosses harry at medial ankle
sinus tarsi syndrome
fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
+/- tears
sinus tarsi syndrome
- fat in sinus tarsi space replaced with scar via hemorrhage or inflamm of synovial recess
- +/- lig tears
- ass: rheum, abN loading
plantar fasciitis thickness cutoff
> 4mm (central band most involved)
progression flat foot
PTT –> spring –> sinus tarsi jacked –> heel strike –> plantar fasciitis
pain at heel, worse with dorsiflexion
plantar fasciitis
split brevis ass
80% lateral lig injruy
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)
mulder’s sgx
squeeze foot –> Morton’s neuroma pops out on sono, pain+
Morton’s neuroma vs inter metatarsal bursitis
neuroma=below plantar lig
-bursiti-extend above transverse lig and has dumbbell shape. <3mm (small)
haglund’s syndrome/deformity aka Mulholland deformity
- retroachilles bursitis
- retrocalcaneal bursitis
- distal achilles thickening
- pst calcaneal bony pump bulb
what’s a synchondrosis?
joint w/ no mvmt, lined with cartilage
os trigonum syndrome
flexor hallus longus during extreme ankle flexion
“ballet dancer”
achilles tendon tear vs xanthoma
Tear UL, weekend warrier, step 1: FQ abx
Xanthoma BL, cholesterol
classic ass calcaneal tuberosity avulsion
DM
achilles tendon tear distance cutoff
4 cm above calcaneal insertion
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
avulsion medial press calcaneal tuberosity/bone spur
plantar fascia rupture
dorsolateral ant calcaneus avulsion fracture
extensor digitorum brevis avulsion
avulsion lateral to calcaneocuboid joint
calcaneocuboid ligament avulsion
pst tibial tendon attachments
hits nav tuberosity –> medial cuneiform –> 2-4 metatarsals
flexor hallucis longus tendon attachements
fib –> btw sesamoids –> base of great toe distal phalynx
flexor digitorum longus attachments
tibia –> base of 2nd-5th distal phalanges
spring ligament
calcaneonavicular ligs
deltoid lig
ant & pst tibiotalar/tibiocalc/tibionav
peroneus brevis distal att
base of 5th metatarsal
peroneus longus distal att
medial cuneiform & 1st metatarsal
normal coracoclavicular distance
- 1-1.3 cm
- increased in ligamentous tears or AC joint injury
origin and distal insertion of bicep brachii
- long head supraglenoid tubercle of scapula
- short head=coracoid
- distal-radial tuberosity
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%-
rotator cuff interval-boundaries and contents
SGHL, coracohumeral ligament, long head bicepss tendon
-space btw supraspinatus & subscapularis
olecranon fossa
- can be seen on AP and lat views
- poss site for loose bodies
lacertus fibrosis
biceps aponeurosis conning bicep tendon to f overlying common flexor m’s.
-biceps tears should be described in relation to this.
cubital tunnel
enclosed by arcuate ligament
What is the only carpal bone with a tendon insertion? what att?
pisiform.
-FCU (then con’t as pisohamate and posometacarpal legs)
Stenner lesion
adductor pollicis
which quadrant of the hip labrum is MC injured?
anterosuperior
normal ration of patella tendon to patella on lateral image/
1 +/- 20%, ie: 0.8- 1.2
segond fracture=avulsion by what structure?
joint capsule
shape of medial and lateral tibial plataeus?
- medial: golf tee
- lateral: hockey puck
Gerdy tubercle
insertion site of IT band (site of avulsion of IT band) on tibia
knee transverse ligament
-connects 2 menisci ant
syndesmotic tibiofibular clear space normal range
4-6 mm or <44% of fibular width
chopart joint
talonavicular and calcaneocuboid joints
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.
pseudo defect of capitellum
coronal img through pst nonarticular asp capitellum
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.
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.
RC innervation
- supra and infraspinatous-suprascapular n
- subscap-subscap nerve
- teres minor-axillary n
anatomy ACL
- 3-5 layers, AM & PL fbrs
- anteromedial tib plateau/spine of medial meniscus –> pst medial lateral femoral condyle
- intra-articular, extra synovial
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
