MSK Trauma Flashcards
differentiate: fatigue fx vs insuff fx
fatigue: normal bone –> repetitive stress –> fx
insuff: abn bone –> normal stress –> fx
tenosynovitis –> cause? (3)
- repetitive motion
- inflamm arthritis
- infx
tenosynovitis –> MRI appearance?
tendon –> completely surround by fluid
what is stenosing tenosynovitis?
tendon sheath –> several loculated fluid collections
what is myxoid degeneration (tendinosis)?
age/over-use –> tendon –> non-inflamm degen
myxoid degeneration (tendinosis) –> MRI appearance?
tendon:
- normal size or enlrg
- intermed signal within
Jones fx –> location?
5th metatarsal –> prox –> meta-diaphysis jx
pseudo-Jones fx (metatarsal base avulsion fx) –> location?
5th metatarsal base –> intra-articular
differentiate: Jones vs pseudo-Jones fx –> prognosis? tx?
Jones fx:
- reduced blood supply –> worse prognosis
- tx variable –> maybe surg
pseudoJones:
- conservative managemt
pseudo-Jones fx (metatarsal base avulsion fx) –> which tendon?
peroneus brevis
what is Freiberg’s infraction?
2nd metatarsal –> head –> avascular necrosis
Freiberg’s infraction –> epidemiology?
young F
Freiberg’s infraction –> cause? (2)
- repetitive stress
- poor fit shoes (heels)
1st toe –> sesamoid fx –> MOA?
1st MTP:
- extreme hyperextend
- dorsal dislocate
what is turf toe?
wide range of injuries of 1st MTP jt –> include sesamoid fx
Lisfranc injury –> 2 dislocation types?
- divergent: 1st metatarsal –> medial dislocate
- homolat: all metatarsals –> lat dislocate
what is Kohler dz?
peds –> navicular –> osteonecrosis
what is Mueller-Weiss dz?
adult –> navicular –> osteonecrosis
Kohler dz –> epidemiology?
M
Mueller-Weiss dz –> epidemiology?
F
differentiate: Kohler dz vs Mueller-Weiss dz –> prognosis?
Kohler –> self-limited
Mueller-Weiss: more severe in course
what is Chopart jt?
talonavicular + calcaneocuboid jt
Chopart fx-dislocation –> assoc fx? (3)
- calcaneus
- cuboid
- navicular
what is lover’s fx?
fall from ht –> calcaneus fx
traumatic calcaneus fx –> next step? why?
high assoc:
- lumbar fx
- traumatic aortic injury
- renal vascular pedicle avulsion
–> further imaging –> lumbar and/or abd
how to measure Boehler angle? normal measuremt?
- posterior tuberosity sup aspect –> post subtalar facet sup aspect
- ant process sup aspect –> post subtalar articular surface sup aspect
normal: 20-40 deg
calcaneus fx –> diagnostic Boehler angle?
<20 deg
calcaneus stress fx –> imaging appearance? Boehler angle?
- calcaneus –> intact cortex –> fluffy band of sclerosis
- normal Boehler angle
talus fx –> which parts of talus can be fractured? (5)
- lat process
- post process
- head
- body
- neck
Hawkins classification –> use for what fx?
talar neck fx
talar neck fx –> potential comp?
disrupt blood supply –> avascular necrosis
what is Hawkins sign?
talar neck fx –> ankle immobilize –> 6-8wk –> intact blood supply –> active hyperemia –> inc bone resorb –> frontal ankle XR –> subchondral lucent band –> good prognosis
talar neck fx –> no Hawkins sign –> suggests?
avascular necrosis
hindfoot (tarsal) coalition –> 2 MC types?
- talocalcaneal
- calcaneonavicular
what is C sign?
fused middle subtalar jt –> medial talus - sustenaculum tali –> talocalcaneal coalition
calcaneonavicular coalition –> fusion of which parts?
calcaneus ant process –> navicular
calcaneonavicular coalition –> sign?
anteater sign
Danis-Weber classification?
- Weber A: distal fibula fx –> intact syndesmosis
- B: prox trans-syndesmotic fx –> partial syndesmotic rupture
- C: high fibula fx above syndesmosis –> assoc total syndesmotic rupture & ankle mortise instable
direction mechanism of trauma?
- Weber A
- B
- C
- Weber A: supination-adduction
- B: supination-ext rot
- C: pronation-ext rot
triplane fx –> 3 components?
- epiphysis –> vertical
- physis –> horizontal
- metaphysis –> oblique
what is Wagstaffe-LeFort fx?
avulsion fx –> distal fibula –> ant –> ATFL
what is maisonneuve fx?
prox fibula fx –> assoc interosseous membrane tear or medial malleolus fx –> wide ankle mortise
what is Pilon fx?
distal tibia –> comminute vertical fx –> tibial plafond disrupt
Pilon fx –> MOA?
axial loading
achilles thicken –> ddx? (2)
- achilles tendinosis
- hyperlipid –> xanthoma
Kager’s fat pad –> inc soft tissue –> ddx? (3)
- # 1 access soleus muscle
- Achilles tendon injury
- Haglund dz (Mulholland deformity)
what is Haglund synd (Mulholland deformity)?
poor fit shoes –> Haglund deformity (“pump bump”) –> retrocalcaneal bursitis –> distal Achilles tendon –> thicken
knee dislocation –> next step? why?
high risk –> popliteal A injury –> CT angio
knee dislocation –> MC type?
ant
tibial plateau fx –> lat vs medial –> which is more stable?
lat
differentiate: meniscal injury –> red zone vs central –> prognosis?
- red zone: vascular zone –> heal spont or w surg
- central: avascular –> not heal
meniscus –> myxoid degen –> imaging appearance?
inc signal –> not extend to surface
meniscal tear –> MC type?
oblique/horizontal tear
meniscus –> oblique/horizontal tear –> MC location?
medial meniscus –> post horn
meniscus –> oblique/horizontal tear –> MC etiology?
degen
meniscus –> what is bucket handle tear?
vertical tear –> inner edge –> displace
meniscus –> bucket handle tear –> most sensitive sign?
“absent bow tie”
meniscus –> bucket handle tear –> displaced inner edge –> MC location?
intercondylar notch
meniscus tear –> double delta sign indicates?
either meniscus –> bucket handle tear –> ant displacement
meniscus tear –> double PCL sign indicates?
medial meniscus –> bucket handle tear –> post displacement
meniscus –> radial (transverse) tear –> sign? (3)
- “marching cleft” sign
- “ghost meniscus”
- “truncated triangle”
meniscus tear –> what is marching cleft sign?
meniscal tear –> oriented obliquely in relation to both coronal and sagittal plane –> tear cleft mv toward/away from free meniscal edge on consecutive sagittal images
meniscus tear –> which type has high rate of meniscal extrusion?
radial (transverse)
what is meniscal cyst?
meniscus tear –> jt fluid extend into –> loculated fluid adj to meniscus
meniscal cyst –> MC assoc meniscus tear?
horizontal tear
what is discoid meniscus?
congenital malformation –> meniscus –> range thick to complete disc-shape –> meniscus extend into central tibial plateau
discoid meniscus –> ssx?
- jt pain
- clicking
- locking
discoid meniscus –> inc risk for? (2)
- cystic degen
- tear
discoid meniscus –> MC in lat or medial meniscus?
lat
discoid meniscus –> imaging appearance?
meniscus –> sagittal –> oval or bowtie –> >3 contiguous slices
ACL –> 2 attachmts? which attachmt is stronger?
- femoral intercondylar notch
- ant tibial plateau –> stronger
ACL –> 2 fiber bundles? which is smaller/larger?
- ant-med band –> small
- post-lat –> lrger
ACL injury –> 3 assoc injuries?
- meniscal tear
- MCL tear
- postlat corner knee injury
what is O’Donoghue’s triad?
- ACL injury
- meniscal tear
- MCL tear
ACL injury –> charact bone contusion pattern?
- lat femoral condyle
- postlat tibial plateau
ACL injury –> PCL appearance?
tibia –> ant displace –> PCL buckling
XR finding –> suggests ACL injury?
Segond fx
what is Segond fx?
lat capsular lig –> lat tibial plateau –> avulsion fx
Segond fx –> assoc injuries? (2)
- ACL
- IT band
IT band –> inserts?
tibia –> Gerdy’s tubercle
XR –> Segond fx –> next step?
MRI –> look for ACL injury
ACL graft –> should run parallel to what structure? what “line” is used to assess this?
parallel to intercondylar notch –> behind Blumensaat’s line
ACL graft –> too steep –> potential comp?
extend leg –> graft impinged by femur
ACL graft –> too lax –> potential comp?
not provide enough knee stability
ACL reconstruction –> what is cyclops lesion?
potential comp of ACL reconstruction –> nodular scarring in Hoffa’s fat pad
ACL vs PCL –> which is stronger?
PCL
PCL –> attachmts?
- femoral intercondylar notch (ant to ACL)
- post tib plateau
PCL injury –> typical MRI appearance?
- inc laxity
- +/- abnormal T2 signal
knee –> extensor mechanism –> 3 components?
- quad tendon
- patella
- patellar tendon
quad muscles? (4)
- vastus –> intermedius, medialis, lateralis
- rectus femoris
patella alta –> Insall-Salvati ratio?
> 1.2
patella baja –> Insall-Salvati ratio?
<0.8
Insall-Salvati ratio –> best measured on sagittal view with how much (deg) flexion?
30deg
quad tendon tear –> ssx? (1)
can’t extend knee
quad tendon tear –> XR finding?
patella baja
patellar tendon tear –> ssx? (1)
can’t extend knee
patellar tendon tear –> XR finding?
patella alta
patellar tendinosis (jumper’s knee) –> MRI appearance?
patellar tendon –> thick
lat patella dislocation –> charact pattern of injury?
- bone contusion:
- lat femoral condyle
- medial patella facet
- medial retinaculum tear
what is Osgood-Schlatter dz? etiology? epidemiology?
adol –> repetitive microtrauma –> tibial tubercle –> osteochondrosis
Osgood-Schlatter dz –> XR appearance?
- tibial tuberosity –> enlrg, fragmted
- adj edema
Osgood-Schlatter dz –> MR appearance?
- tibial tubercle –> BM edema
- distal patellar tendon –> inc signal
- Hoffa’s fat pad –> edema
MCL –> 2 attachmts?
- medial femoral condyle –> post aspect
- tibial metaphysis –> medial aspect –> deep to pes anserinus
MCL injury –> 3 grades?
- Grade 1 –> MCL sprain –> lig normal signal, soft tissue high signal
- 2 –> severe sprain/partial tear –> lig high signal or partial disrupt
- 3 –> complete tear –> complete disrupt
what is Pellegrini-Stieda lesion?
MCL avulsion injury –> medial femoral condyle –> adj calc
lat collateral lig (LCL) complex –> 3 components?
- biceps femoris tendon
- LCL
- IT band
knee –> postlat corner –> componts? (4)
- LCL complex
- arcuate lig
- popliteofibular lig
- popliteus tendon
knee –> postlat corner injury –> surgical-near emergency –> T/F?
T
IT band synd –> epidemiology? MOA? ssx?
runner –> antlat femur & IT band tendon friction –> antlat knee pain
IT band synd –> MRI appearance?
fluid –> both sides of IT band
patella –> 3 facets?
- odd
- med
- lat
cartilage thinning –> reported measuremts?
- <50%
- 50%
- > 50%
cartilage injury –> 3 types of manifestations?
- surface irreg
- fissure
- delamination
cartilage injury –> what is delamination?
dissecting detachmt of cartilage undersurface from bone
what is osteochondrosis dissecans? epidemiology?
adol –> repetitive trauma –> cartilage dehydrate & stiffen –> greater force on subchondral bone –> osteochondral injury
osteochondrosis dissecans –> MC jts? (3)
- # 1 knee
- # 2 ankle
- elbow
osteochondrosis dissecans –> knee –> location?
med femoral condyle –> lat aspect
osteochondrosis dissecans –> ankle –> location?
talar dome:
- postmed
- antlat
osteochondrosis dissecans –> elbow –> location?
capitellum –> antlat
elbow –> osteochondrosis dissecans –> epidemiology? (2)
- gymnast
- throwing athlete
unstable osteochondral fragmt –> appearance?
lesion is not attached to bone –> curvilinear fluid signal bw fragmt & bone
OCD –> MRI stages? (4) which are unstable?
- stage 1: intact articular cartilage
- 2: articular cartilage defect
- 3: displaceable frgmt –> unstable
- 4: displaced frgmt –> unstable
OCD –> MRI stages 1-4 –> XR appearance?
- stage 1: normal
- 2: semicircular frgmt
- 3: semicircular frgmt
- 4: defect or loose body
OCD –> MRI stages 1-4 –> T2 appearance?
- stage 1: BM edema
- 2: surrounding low signal, cartilage defect
- 3: surrounding high signal
- 4: defect and/or loose body
what is osteochondral injury?
cartilage & bone –> acute traumatic injury (not repetitive)
what is pigmented villonodular synovitis (PVNS)?
synovium –> hyperplastic prolif –> benign tumor
same process as pigmented villonodular synovitis (PVNS) –> occurs outside the jt –> dx?
giant cell tumor of tendon sheath
pigmented villonodular synovitis (PVNS) –> MC location?
knee
pigmented villonodular synovitis (PVNS) –> ssx? (3)
- knee pain
- swelling
- knee effusion –> dark brown (d/t prior hemorrhage)
pigmented villonodular synovitis (PVNS) –> MR appearance?
- T1
- T2
- GRE
recurrent hemorrhage –> hemosiderin:
- T1 dark
- T2 dark
- GRE bloom
what is lipoma arborescens?
intracapsule –> synovium –> fatty tissue –> overgrow –> fatty mass –> lobulated & globular
lipoma arborescens –> tx? why?
synovectomy –> prevent premature OA
Baker’s cyst –> MC location?
Baker’s M&M:
- semiMembranosus
- Med head of gastrocnemius
what is Baker’s cyst?
knee jt –> ball-valve type comm –> popliteal cyst
Baker’s cyst –> ddx? (1)
popliteal aneurysm
what is tennis leg?
tear:
- plantaris tendon
- medial head of gastrocnemius
what “line” represents border ant column of acetabulum?
iliopectineal (iliopubic) line
what “line” represents border post column of acetabulum?
ilioischial line
acetabulum fx –> Judet-Letournel classification –> 5 elementary patterns?
- post wall fx
- post column
- ant wall
- ant column
- transverse
hip fx –> intracapsular types? (2)
- femoral head
- neck
intracapsular hip fx –> potential comp?
osteonecrosis
femoral head –> major blood supply? minor?
- # 1 circumflex femoral A
- lig teres
femoral neck fx –> 3 types? MC type?
- # 1 subcapital
- transcervical
- basicervical
subcapital femoral neck fx –> Garden classification?
- stage I: impacted or incomplete –> valgus
- II: complete, nondisplaced
- III: complete, partial displace –> varus
- IV: complete, full displace –> varus
subcapital femoral neck fx –> normal vs varus vs valgus –> angle measuremts?
- valgus >180
- varus <160
- normal 160
hip arthroplasty –> how to optimize MRI?
- field strength
- FSE vs GRE
- receiver bandwidth
- number of acquisitions (NEX)
- artifact direction
- voxel size
- slice thickness
- matrix size
- field strength: low as poss
- FSE vs GRE: FSE
- receiver bandwidth: inc as much as poss
- number of acquisitions (NEX): inc
- artifact direction: sup-inf
- voxel size: dec
- slice thickness: dec
- matrix size: inc
hip fx –> MRI appearance?
- fx line –> T1/T2 dark
- BM edema –> T2 bright
what is magic angle artifact?
short TE seq –> tendon –> oriented 55 deg to magnet bore –> inc signal artifact
short TE –> which seq? (3)
- T1
- proton density
- GRE
hip –> stress fx –> MC location? less common location?
- # 1 femoral neck –> infmed
- femoral head –> sup
differentiate: femoral head stress fx vs hip AVN –> imaging appearance?
stress fx –> subchondral line:
- irreg
- convex to articular surface
AVN –> subchondral line:
- smooth
- concave
hip AVN –> RF? (2)
- steroid use
- alcohol abuse
femur –> stress fx –> atypical location? poss etiology?
bisphosphonate use:
- diaphysis –> lat
- diaphysis –> transverse
hip –> stress fx –> edema should be resolved by?
8wk
hip –> stress fx –> conservative tx for 8 wk –> f/u MRI –> persistent edema –> indicates?
tx fail
stress fx –> other sites in pelvis? (3)
- pubic rami
- sacrum
- acetabulum –> roof
what is AVN? what is osteonecrosis?
AVN: epiphysis/subchondral –> focal ischemia
osteonecrosis: bone & BM –> necrosis
AVN –> natural progression of dz?
focal ischemia –> trabecula necrosis –> inc risk for stress fx –> collapse –> 2ary OA
AVN + splenomeg –> dx?
Gaucher dz
AVN + small calcified spleen –> dx?
sickle cell
AVN –> etiology? (4)
- trauma
- red cell abnormal –> sickle cell
- marrow packing abnormal –> Gaucher
- meds –> steroid, alcohol, transplant immunosupp
hip –> b/l AVN –> suggests what type of etiology?
systemic
AVN –> MC location? 2nd MC?
- # 1 prox femur
- #2 prox humerus
what is Ficat staging used for?
hip AVN –> XR appearance –> staging
hip AVN –> Ficat staging? tx?
- stage 1: normal XR –> core femoral head drill
- 2: cystic & sclerotic change –> core femoral head drill
- 3: subchondral collapse –> variable tx
- 4: femoral head flat, 2ary OA –> jt replace
AVN –> MRI appearance –> 2 classification systems?
- modified Ficat
- Mitchell system
hip AVN –> MC MRI appearance?
- geographic subchondral lesion
- serpentine rim –> T1 dark
pathognomonic sign for AVN?
“double line” sign –> T2:
- peripheral rim –> dark
- inner band –> bright
transient BM edema (TBME; transient osteoporosis of hip) –> classic clinical presentation?
young-middle age adult –> M –> severe hip pain
transient BM edema (TBME; transient osteoporosis of hip) –> XR appearance?
- femoral head –> osteopenia
- normal jt space, acetabulum
- no erosion
transient BM edema (TBME; transient osteoporosis of hip) –> dx of exclusion –> T/F?
T
labral injury –> MC location?
antsup
what is femoroacetabular impingemt?
extreme ROM –> abnormal abutmt of femur w acetabulum
femoroacetabular impingemt –> clinical or imaging dx?
clinical
femoroacetabular impingemt –> natural progression of dz?
young athlete –> impingmt –> microtrauma –> chronic –> early OA
femoroacetabular impingemt –> RF for what injury?
labral
femoroacetabular impingemt –> 3 types? where is the abrnomality?
- cam-type –> femoral head/neck jx
- pincer-type –> acetabulum
- mixed –> both
imaging findings of femoroacetabular impingemt –> impression?
findings may predispose to impingemt in the presence of pain
femoroacetabular impingemt –> cam-type –> abnrmoal bump on femoral head/neck jx –> etiology? (4)
- childhood SCFE
- Legg-Calve-Perthes
- DDH –> sequela
- fx malunion
femoroacetabular impingemt –> cam-type –> epidemiology?
young athlete M
femoroacetabular impingemt –> cam-type –> deformity appearance?
“pistol grip”
femoroacetabular impingemt –> cam-type –> tx?
femoral osteoplasty
femoroacetabular impingemt –> cam-type –> alpha angle is a measure of what?
degree of abnormal femoral bump
femoroacetabular impingemt –> cam-type –> angle angle –> how to measure?
- line thru femoral neck
- line –> femoral head center –> most prox abnormal contour of femoral neck
femoroacetabular impingemt –> cam-type –> abnormal angle angle –> measuremt?
> 55 deg
femoroacetabular impingemt –> pincer-type –> epidemiology?
middle age F
femoroacetabular impingemt –> pincer-type –> tx?
surg –> trim acetabular rim
femoroacetabular impingemt –> pincer-type –> what is crossover sign (cranial acetabular retroversion)?
XR –> frontal –> ant acetabular wall –> sup aspect –> cross over to post acetabular wall
femoroacetabular impingemt –> MC type?
mixed
thoracolumbar spine –> ant column –> componts?
- vertebral body –> ant 2/3
- ALL
thoracolumbar spine –> middle column –> componts?
- vertebral body –> post 1/3
- PLL
thoracolumbar spine –> post column –> componts?
- post elemts
- post lig –> supraspinous, infraspinous, lig flavum
thoracolumbar spine –> post column –> 3 columns –> injury to 1 vs 2 vs 3 columns –> stability?
- 1: stable
- 2: un/stable
- 3: unstable
chance fx (seat belt fx) –> MOA?
sudden decel –> spine –> acute forward flex –> flexion distraction injury
chance fx (seat belt fx) –> appearance?
horizontal split: post elemt –> vertebral body
basion-dental interval –> normal?
<12 mm
atlanto-dental (atlanto-axial) interval (ADI) –> normal?
- adult <2.5mm
- child <5
what is Jefferson fx? MOA?
axial force –> C1 –> ant & post arch –> symm fx
odontoid fx –> 3 types? stability?
- type 1: dens tip –> stable
- 2: base –> unstable
- 3: extend to C2 body –> un/stable
what is Hangman’s fx? MOA?
hyperextend –> C2 –> bilat pedicles/pars interarticularis –> fx
what is clay-shoveler’s fx? MOA?
hyperflex –> C6-T1 –> spinous process –> fx
odontoid fx –> type 2 –> tx?
surg fusion
Hangman’s fx –> charact XR finding?
spinolaminar line –> disrupt
Hangman’s fx –> likely unstable –> what measuremt?
C2-C3 displace >3mm
what is burst fx? MOA?
axial load –> C2-C7 –> same as Jefferson fx
what is flexion teardrop fx? MOA?
hyperflex & compress –> vertebral body –> post displace –> into spinal canal
flexion teardrop fx –> key XR finding? etiology?
ALL avulsion –> vertebral body –> antinf –> bone frgmt
flexion teardrop fx –> potential comp?
ant cord synd –> compress pyramidal tract & ant spinothalamic tract
flexion teardrop fx –> ant cord synd –> clinical presentation?
- complete paralysis
- loss –> pain & temp
differentiate: flexion vs extension teardrop fx
- location?
- stability?
ext:
- higher cervical –> C2-3
- stable
flex:
- lower cervical
- unstable
differentiate: flexion vs extension teardrop fx –> lat XR –> appearance?
ext:
- antinf avulsion frgmt
- no sublux
- spinolaminar line intact
flex:
- antinf avulsion frgmt
- sublux
- spinolaminar line disrupt
what is bilat interfacetal dislocation (bilat locked facets)? MOA? MC location?
hyperflex –> lower cervical –> all spinal lig –> complete disrupt –> vertebra –> ant dislocate –> >50%
perched facet –> how much ant sublux –> measuremt?
> 3mm, but less than 50%
what is naked facet sign?
sup articular facet –> not covered by adj inf facet
differentiate –> bilat vs unilat locked facet –> stability?
bilat –> unstable
unilat –> stable
what is Grisel synd? MC etiology?
pharyngitis/retropharyngeal mass –> inflamm mass –> C1-C2 –> rotatory subluxation
AC jt injury –> epidemiology? MOA?
YA athlete –> lat shoulder –> downward blow
AC jt space –> normal measuremt?
<5mm
coracoclavicular jt space –> normal measuremt?
<11-13mm
bilat –> AC & coracoclavicular jt –> asymm of how much is abnormal?
> 50%
AC jt injury –> grading system?
- grade I: AC lig sprain –> normal XR
- II: AC disrupt, CC intact
- III: AC + CC disrupt
- IV: distal clavicle –> post displace
- V: severe grade 3 –> >100% displace
- VI: distal clavicle –> inf displace
what is Hill-Sachs lesion? location?
humeral head –> postlat aspect –> compression fx
Hill-Sachs lesion –> XR –> best seen on what view?
AP –> int rot
what is Bankart –> lesion vs bony? location?
glenoid –> ant-inf rim:
- lesion –> labrum only (+ periosteum)
- bony –> fx
shoulder –> post dislocation –> etiology?
severe muscle spasm:
- sz
- electrocute
post shoulder dislocate –> XR –> best seen on what view?
transscapular Y
post shoulder dislocate –> XR –> Grashey view –> appearance?
humeral head –> overlap w glenoid
post shoulder dislocate –> 2 signs?
- lightbulb sign –> fixed int rot –> humeral head appearance
- trough sign (reverse Hill-sachs) –> humeral head –> antmed aspect –> compression fx
inf shoulder dislocate (luxatio erecta) –> assoc injuries? (2)
- rotator cuff tear
- grter tuberosity fx
inf shoulder dislocate (luxatio erecta) –> potential comp?
axillary nerve/art injury
inject fluid –> glenohumeral jt –> extend into subacromial/subdeltoid bursa –> dx?
complete rot cuff tear
shoulder impingemt synd –> clinical or imaging dx?
clinical
shoulder impingemt synd –> extrnsic impingmt –> 2 types? which is MC?
- # 1 primary external impingemt
- subcoracoid impingemt
shoulder impingemt synd –> extrnsic impingmt –> primary external subtype –> MOA?
coracoacromial arch –> variant anatomy:
- subacromial enthesophyte
- hooked acromion
- AC jt osteophyte
- os acromiale
- thick corocoacromial lig
shoulder impingemt synd –> extrnsic impingmt –> primary external subtype –> epidemiology?
young athlete –> repetitive overhead mvmt (throwing)
shoulder impingemt synd –> extrnsic impingmt –> primary external subtype –> chronic –> comp?
- supraspin tendon +/- long head biceps tendon –> degen/tear
- subacromial/subdeltoid bursitis
shoulder impingemt synd –> extrnsic impingmt –> subcoracoid impingemt subtype –> MOA?
narrow coracohumeral distance
shoulder impingemt synd –> intrnsic impingmt –> MOA?
rot cuff/jt capsule –> abnormality –> glenohumeral instable
os acromiale –> can be asympt –> what imaging finding suggests os may be cause of pain?
BM edema
os acromiale –> tx?
- resect
- fuse
rot cuff –> 4 componts?
- supraspin
- infraspin
- teres min
- subscap
rot cuff –> which insert on grter tuberosity? lesser?
grter:
- supraspin
- infraspin
- teres min
lesser:
- subscap
rot cuff –> what is “footprint”?
attachmt of tendons at grter tuberosity
rot cuff –> what is “critical zone”?
supraspin tendon –> 1cm prox to insertion site –> potentially undervascularized –> predispose to rupture
rot cuff –> 2 MC injured compont? least?
#1 supraspin #2 infraspin
least –> teres min
rot cuff –> partial tear –> 3 types? MC?
- # 1 articular surface
- bursal surface
- intrasubstance
rot cuff –> what is “rim rent” tear?
aka partial thickness articular supraspin tendon avulsion (PASTA) lesion:
supraspin –> insertion site –> articular surface –> avulsion –> partial tear
rot cuff –> what is “PAINT” lesion?
partial articular tear w intratendinous extension: PASTA/rim rent tear –> tear extend into tendon
supraspin tear –> 1/3 assoc other injuries? (2)
- infraspin tear
- biceps tendon injury
RA –> rot cuff complete tear –> chronic –> classic appearance?
humeral head –> migrate sup –> may articulate w acromion
rot cuff –> full thick tear –> how classified?
length of affected tendon:
- <1cm small
- > 5cm massive
rot cuff atrophy –> MCC? less common cause?
- # 1 chronic rot cuff tear
less common –> denervation
rot cuff tear –> fatty degen –> how long after injury? reversible or irrev?
4wk –> irrev
rot cuff –> fatty infilt –> assess on which plane?
sag
rot cuff –> fatty infilt –> classification system?
Goutallier classification
Goutallier classification?
- grade 0: normal, no fat
- 1: few fat streaks
- 2: muscle > fat
- 3: muscle = fat
- 4: msucle < fat
denervation –> rot cuff atrophy –> assoc finding?
paralabral cyst
what is adhesive capsulitis (frozen shoulder)?
jt capsule & synovium –> inflamm –> jt capsule thick & contract
adhesive capsulitis (frozen shoulder) –> clinical or imaging dx?
clinical
adhesive capsulitis (frozen shoulder) –> MRI finding? (2) measuremt?
- jt capsule & synovium –> thick >4mm
- rot cuff interval –> loss of fat
shoulder –> what is rotator interval?
bw supraspin & subscap tendons –> triangle region –> allow rotation mvmt around coracoid
shoulder –> rotator interval –> contains what 3 struct?
- coracohumeral lig
- long head biceps tendon
- sup glenohumeral lig
3 glenohumeral lig?
- sup
- middle
- inf
coracohumeral lig –> attachmts?
- coracoid process
- humerus –> grter tubercle
“biceps pulley” –> 3 compnts?
- sup glenohumeral lig
- coracohumeral lig
- supraspin tendon
coracohumeral lig –> location –> internal or ext to jt capsule?
ext
sup glenohumeral lig –> attachmts?
- scapula –> supraglenoid tubercle-
- humerus –> lesser tuberosity
middle glenohumeral lig –> attachmts?
- scapula –> supraglenoid tubercle-
- humerus –> lesser tuberosity
middle glenohumeral lig –> congenitally absent –> what % of pts?
1/3
middle glenohumeral lig –> tear –> assoc other injury?
sup labrum tear
inf glenohumeral lig –> attachmts?
- humerus –> anatomic neck
- inf glenoid labrum
inf glenohumeral lig –> 3 compnts?
- ant band
- axillary pouch
- post band
capsulolabral complex –> abduction & ext rot stability –> #1 important compnt?
inf glenohumeral lig
long head biceps tendon –> attachmt?
antsup glenoid rim
long head biceps tendon –> fluid in tendon sheath –> can be normal –> why?
biceps tendon sheath –> comm w glenohumeral jt
what is biceps pulley? fx?
bicipital groove –> capsuloligamentous complex –> sling –> stabliize biceps tendon
biceps tendon sublux –> definition?
tendon –> bicipital groove –> displaced from, but still in contact w
biceps tendon sublux/dislocation –> assoc other injury?
transverse lig injury
transverse humeral lig –> attachmts?
- grter tuberosity
- lesser tuberosity
biceps tendon dislocation –> assoc other 2 injuries in conjunction?
- transverse lig
- biceps pulley
biceps tendon –> medial dislocation –> assoc other injury?
subscap tendon tear
what is shoulder instability?
mv –> humeral head –> abnormal motion relative to glenoid
shoulder instability –> 3 manifestations?
- dislocate
- sublux
- microinstable
glenohumeral jt –> soft tissue stabilizers –> dynamic componts? (2)
- rot cuff
- biceps tendon
glenohumeral jt –> soft tissue stabilizers –> static componts? (4)
capsulo-labro-lig complex:
- bony glenoid fossa
- labrum
- coracohumeral lig
- sup/mid/inf glenohumeral lig
glenohumeral jt –> traumatic instability –> aka?
TUBS:
- traumatic
- unidirectional
- Bankart
- surgical
glenohumeral jt –> atraumatic instability –> 2 types?
AIOS:
- acquired
- instability
- overstress
- surgery
AMBRI:
- atraumatic
- multidirectional
- bilat
- rehab
- inf capsule shift
glenohumeral jt –> atraumatic instability –> AIOS subtype –> epidemiology? MOA?
athlete –> repetitive mvmt
glenohumeral jt –> atraumatic instability –> AMBRI subtype –> etiology?
congenital jt lax
shoulder –> labral injury –> how to describe location of injury? (2)
- clock
- sextant
shoulder –> what is sublabral foramen?
10% –> normal variant –> labrum –> antsup segmt –> not attached to bony glenoid
shoulder –> what is Buford complex?
- 5% –> normal variant:
- labrum –> antsup segmt –> absent
- middle glenohumeral lig –> thick cord-like
shoulder instability lesions –> MC location?
- antinf aspect of glenohumeral jt
- assoc w ant band of inf glenohumeral lig
what is glenoid labrum ovoid mass (GLOM) sign?
ant labrum –> tear –> retract sup –> dark ovoid mass ant to labrum
MRI –> shoulder –> intra-articular –> black mass –> ddx? (3)
- GLOM sign
- dislocated biceps tendon
- air bubble
bony Bankart –> RF for what?
glenoid insuff –> recurrent dislocate
what is ant labro-lig periosteal sleeve avulsion (ALPSA)?
Bankart lesion –> but intact periosteum
ant labro-lig periosteal sleeve avulsion (ALPSA) –> balled-up labrum –> displaces to what location?
inf-med
what is Perthes lesion?
labrum –> antinf avulsion –> remain attached to periosteum
Perthes lesion –> best imaging modality? best positioning?
MR arthrography –> abd-ext rot (ABER)
what is humeral avulsion of inf glenohumeral lig (HAGL)?
inf glenohum lig –> humeral attachmt –> avulsion
humeral avulsion of inf glenohumeral lig (HAGL) –> assoc other injury?
subscap tendon tear
what is bony humeral avulsion of inf glenohumeral lig (BHAGL)?
HAGL + humerus –> anatomic neck –> bony avulsion
shoulder –> post instability –> assoc other injuries? (2)
- infraspin
- teres minor
shoulder –> post instability –> a congenital cause?
hypoplastic post glenoid
what is Bennett lesion (thrower’s exostosis)?
inf glenohumeral lig –> post band –> avulsion –> extra-articular posterior ossification
Bennett lesion (thrower’s exostosis) –> epidemiology?
baseball pitcher
what is sup labrum ant post (SLAP) tear?
biceps tendon attachmt –> sup labrum –> tear –> ant-post orient
sup labrum ant post (SLAP) tear –> MC type? MC etiology?
type II
repetitive microtrauma
sup labrum ant post (SLAP) tear –> 4 types?
- type I: sup labrum –> fray
- II: I + stripped
- III: bucket handle tear
- IV: III –> extend into biceps tendon
what is glenoid labral articular disruption (GLAD)?
- antinf labrum –> superficial tear
- adj glenoid articular cartilage injury
glenoid labral articular disruption (GLAD) –> assoc w shoulder instability –> T/F
F
glenoid labral articular disruption (GLAD) –> potential comp?
post-trauma arthritis –> intra-art bodies
labral tear –> specific finding?
paralabral cyst
paralabral cyst –> potential comp?
compress nerve –> entrapmt neuropathy
quadrilateral space –> location? boundaries?
axilla -> post aspect:
- humerus
- long head triceps
- teres minor
- teres major
quadrilateral space –> contains what N & A?
- axillary N
- post humeral circumflex A
what is quadrilateral space synd?
quad space –> axillary N entrap –> teres minor +/- deltoid –> paresthesia –> atrophy
suprascapular notch –> contains what N & A?
prox suprascap N & A
suprascapular notch –> prox suprascap N –> entrap –> what muscles affected?
- supraspin
- infraspin
suprascapular notch –> prox suprascap N –> entrap –> MCC?
sup labral tear –> paralabral cyst
spinoglenoid notch –> what N?
distal suprascap N
spinoglenoid notch –> distal suprascap N entrap –> what muscle affected?
infraspin
what is Parsonage-Turner synd?
idiopathic brachial neuropathy –> rot cuff atrophy
Parsonage-Turner synd –> how dx?
dx of exclusion –> 1st r/o structure causes for atrophy –> ie mass/cyst compress N
elbow dislocation –> MC type?
radius + ulna –> post dislocate
XR –> elbow dislocation –> next step? why?
XR forearm –> look for ulna fx
XR elbow –> fat pad sign –> no identifiable fx –> next step?
- XR –> additional views –> radial head
- CT
what is Essex-Lopresti fx-dislocation?
- radial head fx
- tear interosseous membrane –> distal radioulnar jt –> ulna dislocation
what is Monteggia fx-dislocation?
- ulna fx
- elbow –> radius dislocate
what is Galeazzi fx-dislocation?
- radius fx –> distal 1/3
- distal radioulnar jt –> ulna dislocate
Colles fx –> usu intra-art extension –> T/F?
T
what is Hutchinson (chauffer’s) fx?
distal radius –> radial aspect –> fx –> extend to radial styloid & radiocarpal jt
what is perilunate dislocation?
capitate –> dislocate from lunate
what is lunate dislocation?
lunate –> dislocate volar
scapholunate advanced collapse (SLAC) –> etiology? (3)
- OA
- CPPD arthropathy
- chronic untreated scapholunate dissociation
scapholunate lig injury –> sign?
Terry Thomas sign
what is scapholunate advanced collapse (SLAC)?
sequela of chronic scapholunate lig injury
Kienbock dz –> assoc other finding?
neg ulnar variance (ulna shorter than radius)
Kienbock dz –> MOA?
inc load on lunate
mallet finger –> MOA?
direct impact –> tip of finger –> DIP –> disrupt extensor tendon
Boutounniere deformity –> MOA?
PIP –> extensor tendon –> medial slip –> injury –> PIP jt herniate thru –> become entrapped
Boutounniere deformity –> etiology? (2)
- # 1 RA
- trauma
what is gamekeeper’s (skier’s) thumb? MOA?
force abduct –> thumb –> prox phalanx base –> ulnar collateral lig –> injury
differentiate: ulnar collateral lig –> tear –> incomplete vs complete –> tx?
- incomplete –> conservative
- complete –> surg
ulnar collateral lig tear –> potential comp?
Stener lesion:
- UCL injury
- adductor aponeurosis interposition
Stener lesion –> tx?
surg
what is Bennett fx?
1st metacarpal base –> fx –> intra-articular
what is Rolando fx?
Bennett fx –> comminuted
what is Boxer’s fx?
metacarpal neck fx (usu 5th metacarpal)
what is volar plate fx? MOA?
hyperextend –> middle phalanx –> proximal –> volar aspect –> fx
carpal tunnel –> contains what struct? (10)
- 4 flexor dig profundus
- 4 flexor dig superficialis
- 1 flexor pollicis longus
- 1 median N
lister’s tubercle –> can cause rupture of what tendon?
3rd extensor tendon (EPL)
carpal tunnel synd –> assoc w diaysis –> T/F?
T
carpal tunnel synd –> imaging finding –> bowing of what struct?
flexor retinaculum
extensor carpi ulnaris –> dislocate –> med or lat?
med
Bennett fx –> metacarpal base fx –> dorsolat displace –> what tendon is involved?
abd pollicis longus
gamekeeper’s/skier thumb –> what tendon is involved?
ulnar collateral lig
gamekeeper’s/skier thumb –> comp?
stenor lesion
what is stenor lesion?
ulnar collateral lig –> torn –> adductor tendon aponeurosis –> get caught in torn edge
stenor lesion –> classic “sign”
yoyo on a string
stenosing tenosynovitis (trigger finger) –> imaging finding?
thick tendon sheath
cubital tunnel synd –> MCC?
accessory anconeus (anconeus epitrocholearis)
lat epicondylitis –> aka? MOA?
tennis elbow –> repetitive extend
med epicondylitis –> aka? MOA?
golf elbow –> repetitive flex
elbow –> partial ulnar collateral lig tear –> imaging sign?
T sign –> contrast medial extend medial to medial coronoid (sublime tubercle)
elbow –> ulnar collateral lig –> composed of 3 lig –> which is most important?
ant bundle
elbow –> partial ulnar collateral lig tear –> epidemiology? MOA?
thrower –> valgus overload
thrower –> elbow –> valgus overload synd –> synd? (3)
- ulnar collateral lig injury –> usu ant band
- post humerus/ulna arthritis
- capitellum OCD
what is little leaguer elbow?
throw –> repetitive chronic microinjury –> medial epicondyle apophysis:
- stress fx
- avulsion
- delayed closure
little leaguer elbow –> other assoc injury?
ulnar collateral lig injury
epitrochlear LAD –> ddx? (1)
cat scratch dz
partial biceps tear –> assoc condition?
bicipitoradial bursitis
triceps rupture –> assoc other injury?
Salter Harris 2 fx of olecranon
reverse shoulder arthroplasty –> indication? (2)
- proximal humerus fx –> 3-4 parts
- rot cuff is trashed
reverse shoulder arthroplasty –> comp? (1)
excess deltoid tugging –> post acromion fx
rot cuff is trashed –> can get reverse shoulder arthroplasty –> requires what struct to be intact?
deltoid
ext shoulder impingemt –> subacromial –> involve which tendon?
supraspin
ext shoulder impingemt –> subcorocoid –> involve which tendon?
subscap
int shoulder impingemt –> postsup –> involve which tendon?
infraspin
rot cuff –> partial tear –> % tear for surgical intervention?
> 50%
what is massive rot cuff tear?
tear of at least 2 of 4 rot cuff muscles
multidirectional glenohumeral instability –> glenohumeral vol –> dec/normal/inc?
inc
adhesive capsulitis (frozen shoulder) –> glenohumeral vol –> dec/normal/inc?
dec
SLAP –> assoc w instability –> T/F?
F
trauma –> foot in int rot –> what type of hip dislocation?
post hip dislocate
hip fx –> intracapsular –> degree of displacemt corresponds to risk of AVN –> T/F?
T
snapping hip synd –> etiology? (3) MC?
- # 1 external –> iliotibial band over grter trochanter
- internal –> iliopsoas over iliopectineal eminence or femoral head
- intra-articular –> labral tear, loose bodies
snapping hip synd –> iliopsoas over iliopectineal eminence or femoral head (internal type) –> how to eval for?
US
hip –> labral tear –> MC type?
ant-sup
os acetabuli –> assoc conditions? (2)
- labral tear
- femoroacetabular impingemt
Segond fx –> MOA?
int rot
reverse Segond fx –> fx of what struct?
medial tibial plateau
reverse Segond fx –> assoc other injuries? (2)
- PCL tear
- medial meniscus injury
reverse Segond fx –> MOA?
ext rot
what is arcuate sign?
proximal fibula –> avulsion
arcuate sign –> assoc other injury? (1)
cruciate lig injury –> usu PCL
what is deep intercondylar notch sign?
impaction injury –> depression of lat femoral condyle
deep intercondylar notch sign –> assoc other injury?
ACL injury
ACL mucoid degen –> imaging sign? (2)
- T1 –> “drumstick”
- T2/STIR –> “celery stick”
ACL mucoid degen –> comp?
ACL ganglion cyst
ACL repair –> clinical significance of…?
- femoral tunnel
- tibial tunnel
- femoral tunnel –> maintain isometry
- tibial tunnel –> roof impingemt
ACL repair –> 16wk later –> extend knee –> palpable audible chunk –> dx?
arthrofibrosis
ACL repair –> arthrofibrosis –> imaging finding?
Hoffa’s fat pad –> mass-like scar (cyclops lesion) –> low signal
ACL graft –> should be parallel to intercondylar notch –> if become more horizontal –> dx?
graft tear
fibular head edema –> ddx? (1)
post lat corner injury
patella tendon tear –> classic assoc condition?
SLE
bilat patella tendon tear –> classic predisposing factor?
chronic steroid
acute flat foot –> dx?
post tib tendon injury
ankle –> ATFL & tibfib lig injury –> lateral instability –> chronic synovial inflamm –> comp?
lat gutter –> mass of hypertrophic synovial tissue –> antlat impingemt synd
ankle –> antlat impingemt synd –> MRI finding?
lat gutter –> “meniscoid mass” (balled up scar) –> T1/T2 dark
tarsal tunnel –> general location?
behind med malleolus
tarsal tunnel synd –> involved N? distribution of pain?
post tib N –> 1st 3 toes
tarsal tunnel –> covered by what struct?
flexor retinaculum
tarsal tunnel –> contains what struct? (5)
- post tib A & N
- tib post (“tom”)
- flex dig long (“dick”)
- flex hallicus long (“harry”)
morton neuroma –> is it a neuroma or scar?
scar
ballet dancer –> what condition?
os trigonum synd
calcaneal tuberosity avulsion –> underlying condition?
DM
achilles tendon rupture but can still plantarflex –> dx?
plantaris rupture (tennis leg)
plantaris rupture (tennis leg) –> imaging appearance?
fluid collection bw soleus & med head of gastroc
what is spring ligament?
group of calcaneonavicular ligaments
what is deltoid ligament?
complex of medial collateral ligaments of ankle