Musculoskeletal Flashcards
What does FEGNOMASHIC stand for?
Fibrous dysplasia
Enchondroma/ eosinophilic granuloma
Giant cell tumour
Nonossifying fibroma
Osteoblastoma
Metastatic diseases/ myeloma
Aneurysmal bone cyst
Solitary bone cyst
Hyperparathyroidism/ haemangioma
Infection
Chondroblastoma/ chondromyxoid fibroma
What are the common sites of fibrous dysplasia?
Pelvis, proximal femurs, ribs, skull
Differential for lytic lesion with bony sequestrum?
Lymphoma
Langerhans’ cell histiocytosis or eosinophilic granuloma
Osteomyelitis
Fibrosarcoma
Osteoid osteoma will give appearance of sequestrum when nidus is partially calcified
What is the differential for lytic bone lesion in the epiphysis in patients under 30?
Osteomyelitis
Chondroblastoma
Giant cell tumour
Skull lucencies in a geographic appearance are seen in which condition?
Langerhans’ cell histiocytosis or eosinophilic granuloma
(also have bevelled/scalloped appearance)
What are the three features of McCune Albright syndrome?
Multi-focal fibrous dysplasia
Café-au-lait spots
Precocious puberty
What are the causes of a pseudopermeative process
i.e. cortical process with cortical holes?
Osteoporosis
Haemangioma
Radiation
What is the differential for diffuse osteosclerosis?
Renal osteodystrophy
Sickle cell disease
Myelofibrosis
Osteopetrosis
Pyknodysostosis
Metastatic carcinoma
Mastocytosis
Paget’s disease
Athletes
Fluorosis
What is the differential for fluid-fluid levels in bone lesions?
Aneurysmal bone cyst
Telangiectatic osteosarcoma
Giant cell tumour
Which lesions affect the epiphysis?
Aneurysmal bone cyst
Infection
Giant cell tumour
Chondroblastoma
Clear cell chondrosarcoma
What is the classic differential for lucent lesion in the posterior elements?
ABC
Osteoblastoma
TB
In which disorders can you get subchondral cysts/geodes?
Degenerative joint disease
Rheumatoid arthritis
CPPD
AVN
What are the causes of a high riding humeral head?
Rheumatoid arthritis
Torn rotator cuff
CPPD
What are the radiographic hallmarks of rheumatoid arthritis?
Loss of joint space
Osteoporosis
Soft tissue swelling
Erosions (marginal)
*Femoral head also migrates axially, rather than superiorly as seen in OA
Which conditions have classically MARGINAL SYMMETRICAL SYNDESMOPHYTES?
Ankylosing spondylitis
Inflammatory bowel disease
What conditions classically have NON MARGINAL, ASSYMETRIC SYNDESMOPHYTES?
Psoriatic arthritis
Reactive arthritis
What are the imaging features of gout?
Well defined erosions with sclerotic borders and overhanging edges
Soft tissue nodules (can calcify presence of renal failure)
WITHOUT marked osteoporosis
Random distribution
Marked soft tissue wasting in the hands with ulnar deviation of the phlanges are hallmarks of what disease?
Systemic lupus erythematosis
What are the hallmarks of haemochromatosis in the hands?
Degenerative joint diseases 2nd-4th MCPs
Squaring of metacarpal heads
“Drooping” osteophytes (also seen in CPPD)
50% also have CPPD- look for chondrocalcinosis
What conditions cause epiphyseal enlargement (overgrowth)?
Juvenile idiopathic arthritis
Haemophilia
Paralysis
12 yr old female with joint pain, soft tissue swelling, osteopenia, loss of joint space, erosions, growth disturbance and hepatosplenomegaly
Juvenile Idiopathic Arthritis (JIA)
Aggressive osteoporosis, pain, soft tissue swelling and skin atrophy following minor trauma is called what?
Sudeck atrophy
(complex regional pain syndrome/ reflex sympathetic dystrophy)
What is the characteristic skin lesion seen in mastocytosis?
Urticaria pigmentosa
(Patients with mastocytosis also have uniformly increased bone density and thickened small bowl folds with nodules)
Where would you typically find a CORTICAL DESMOID and which muscle attaches there?
Medial supracondylar ridge of distal femur (posterior)
ADDUCTOR MAGNUS tendon attaches here.
What is the differential for a periosteal reaction in a long bone without an underlying bone lesion?
Hypertrophic (pulmonary) osteoarthropathy
Venous stasis
Thyroid acropachy
Pachydermoperiostosis
Trauma
Regions of sclerosing bone, cortical thickening with a “dripping wax” appearance
Melorheostosis
55 yr old with metadiaphyseal sclerosis with sparing of epiphyses, diabetes incipidus, exophthalmos and bone pain
Erdheim-Chester disease
What are the imaging characteristics of a Morton’s neuroma?
Low signal on T1, T2 and STIR
Usually enhance with gadolinium
Hypoechoic mass on ultrasound
In which conditions would you see a “Shepherd’s crook” deformity of the proximal femur?
Fibrous dysplasia
Paget’s disease
Osteogenesis imperfecta
What is the differential diagnosis for widening of the intercondylar notch?
Rheumatoid/JIA
Psoriatic arthropathy
Haemophilia
TB
What is a differentiating feature of malignant fibrous histiocytoma (MFH) vs myositis ossificans?
Myositis ossificans can cause a periosteal reaction but WILL NOT cause bony erosions, MFH can cause cortical erosion.
What are the names of the 9 flexor tendons which pass through the carpal tunnel?
Flexor digitorum profundus (x4)
Flexor digitorum superficialis (x4)
Flexor pollicis longus (x1)
32 yr old man with osteonecrosis, splenomegaly and Erlenmeyer flask deformity. Diagnosis?
Gaucher disease
What is a Madelung deformity?
Bowing of the radial shaft with ↑ interosseous space and dorsal subluxation of distal radio-ulnar joint
Decreased carpal angle < 120°
“V-shaped” proximal carpal row
Positive ulnar variance
What is the differential for arthritis with NO demineralisation?
NO DEMINERALISATION
Psoriatic
Osteomyelitis
Neuropathic joint
Gout
Sarcoidosis
What is the differential for arthritis with demineralisation?
DEMINERALISATION
Haemophilia
Osteomalacia
Rheumatoid/Reiters
Scleroderma
ESLE
Name the different aetiologies of a Madelung deformity.
Dysplastic (Ollier, osteochondromatosis, achondroplasia, mucopolysaccharidosis, MHE)
Idiopathic
Genetic (Turner syndrome most common)
Infection
Traumatic
What are the imaging features of tuberculous discitis?
Calcification (almost pathognomonic)
Involvement of posterior elements
Insidious onset
Less loss of disc space
Gibbus deformity (angular kyphosis)
Multiple levels involved
Which dermatome supplies the area over the deltoid?
C5
Which dermatome supplies the middle finger?
C7
Which dermatome supplies the xiphisternum?
T8
Which dermatome supplies the thumb?
C6
Which dermatome supplies the little finger?
C8
Which dermatome supplies the ischial tuberosity area?
S3
Which dermatome supplies the perianal region?
S4/5
Which dermatome supplies the nipple line?
T4
Which dermatome supplies the umbilicus?
T10
Which dermatome supplies the medial aspect of the calf?
L4
Which dermatome supplies the web-space between the 1st and 2nd toes?
L5
Which dermatome supplies the lateral border of the foot?
S1
What is the differential for a block vertebra (failure of separation of two or more adjacent vertebral bodies)?
Klippel-Feil syndrome
Rheumatoid arthritis
Ankylosing spondylitis
Post-operative
Post-traumatic
Post-TB infection
What is the most common congenital shoulder abnormality?
Sprengel deformity
Patients with Sprengel deformity of the shoulder often have which other abnormalities?
Klippel-Feil syndrome
Spina bifida
Kyphoscoliosis
Torticollis
Under-development of the clavicle or humerus
What are the features of a Sprengel shoulder?
Elevation and rotation of the scapula with the inferior angle directed laterally.
Omovertebral bar (fibrous, cartilaginous and/ or osseous connection between the scapula and cervical spine).
Hypoplasia or atrophy of regional muscles.
Which spinal level is supplies quadriceps, patella reflex and sensation over the knee/ shin?
L3 /4
Which spinal level supplies the iliopsoas and hip adductors and the anterior thigh sensation?
L1 /2
Which spinal level supplies hip extension, extension of the big toe, ankle inversion, ankle reflex and sensation to the sole of the foot?
L5/S1
Which spinal level supplies iliopsoas and hip adductors and medial thigh and knee sensation?
L2 /3
Which spinal level supplies dorsiflexion of the foot, ankle eversion and sensation to the lateral calf?
L4 /5
What is the differential for posterior vertebral body scalloping?
Syringomyelia
Achondroplasia
Tumours (ependymoma, lipoma, dermoid, neurofibroma)
Acromegaly
Neurofibromatosis type 1
What is the most reliable sign of AVN?
Dark signal on T1
What is O’Donoghue’s triad?
ACL tear
MCL tear
Medial meniscal injury
What are the causes of erosion of the lateral clavicles?
Hyperparathyroidism
Rheumatoid arthritis
Scleroderma
Psoriatic arthropathy
Cleidocranial dysostosis
What is the differential for an ivory vertebra in an adult?
Paget
TB spondylitis
Haemangioma
Metastases
What is the differential for an ivory vertebra in a child?
Lymphoma
Osteosarcoma
Osteoblastoma
Ewing sarcoma
Metastatic medulloblastoma
Which fracture is associated with a perilunate dislocation?
Scaphoid in 60%
Describe the features of perilunate dislocation in terms of the scapholunate and capitolunate angles.
Lunate remains in articulation with the radius
Reduced scapholunate angle (<30) and increased capitolunate angle (>60)
Associated with a scaphoid fracture
Which other injuries are associated with a midcarpal dislocation?
Triquetrolunate interosseous ligament disruption
Triquetral fracture
What other injury is associated with a lunate dislocation?
Dorsal radiolunate ligament injury
Describe the features of a lunate dislocation.
Lunate displaced and volarly rotated
Disruption of all perilunate ligaments
Describe a midcarpal dislocation
Dislocation of the capitate from the lunate and subluxation of the lunate from the radius
What happens to the scapholunate angle with dorsiflexion of the lunate in dorsal intercalated segmental instability?
Widens to >60
The pull of which tendon is responsible for the dorsolateral dislocation in a Bennett fracture?
Abductor pollicis longus
What is the eponymous name for an avulsion fracture of the base of the proximal 1st phalanx associated with ulnar collateral ligament disruption?
Gamekeepers thumb
What is a Stener lesion?
Following gamekeepers thumb there is slippage of the torn end of the ulnar collateral ligament superficial to the adductor pollicis muscle so that there is interposition of the adductor pollicis muscle between the ulnar collateral ligament and the MCP joint.
Guyon’s canal is formed by which bones?
Pisiform and hamate
What passes through Guyon’s canal?
Ulnar nerve, artery and vein
Posterior dislocation at the elbow is associated with what fracture?
Capitellum
What is a Monteggia fracture?
Fracture of the proximal ulna with anterior dislocation of the radial head
What is a Galeazzi fracture?
Radial shaft fracture
Anterior dislocation of the ulna at the distal radioulnar joint
A Hill Sachs fracture is best seen on which view?
Internal rotation view
Inferior dislocation normally results in an injury to what structure?
Axillary nerve
Fracture of the iliac crest results from an avulsion of which muscle?
Abdominal muscles
Fracture of the ASIS results from an avulsion of which muscle?
Sartorius
Fracture of the AIIS results from an avulsion of which muscle?
Rectus femoris
Fracture of the greater trochanter results from an avulsion of which muscle?
Gluteal muscles
Fracture of the lesser trochanter results from an avulsion of which muscle?
Illiopsoas
Fracture of the symphysis results from an avulsion of which muscle?
Adductors
Fracture of the ischial tuberosity results from an avulsion of which muscle?
Hamstrings
Which patients get pincer type femoroacetabular impingement?
Middle aged women
Which patients get cam type femoroacetabular impingement?
Young males
What is pincer type femoroacetabular impingement?
Over-coverage of the femoral head by the acetabulum
What is cam type femoroacetabular impingement?
Bony protrusion on the antero-superior femoral head-neck junction
A segond fracture is a fracture of where?
Lateral tibial plateau
(occurs with internal rotation)
An avulsion fracture of the proximal fibula at the insertion of the arcuate ligament complex is associated with what other injury in 90%?
Cruciate ligament, usually PCL
What is commonly associated with a patellar tendon tear?
SLE
(but also trauma, RA, elderly)
Which tendons can become entrapped with lateral calcaneal fractures?
Peroneal tendons
Spontaneous osteonecrosis of the knee is commonly found in what location?
Medial femoral condyle
What is a T-score in regards to DEXA scanning?
Bone density relative to a young adult
What is a normal T score on DEXA scan?
> 1.0
What is the osteopenia T-score range?
-1.0 to -2.5
What is the T-score for osteoporosis?
< -2.5
Which tendons are affected in De Quervains tenosynovitis?
Abductor pollicis longus and extensor pollicis brevis (1st compartment)
AVN of the lunate (Kienbocks) is associated with what?
Negative ulnar variance
What are the MRI features of a glomus tumour of the finger?
T1 low, T2 bright, avid enhancement
What are the MRI features of a giant cell tumour of the tendon sheath of the finger?
T1/T2 dark
blooming artefact on gradient
What are the MRI features of a fibroma of the finger?
T1/2 dark
Will not have blooming artefact like the giant cell tumour
Where is the most common location for an acetabular labral tear?
Anterior superior labrum
Intersection syndrome is a repetitive use issue resulting in tenosynovitis of which tendons?
Extensor carpi radialis brevis and longus
Diffuse tenosynovitis of the hand and wrist with sparing of the muscles in an immunocompromised patient. Diagnosis?
Non-tuberculous mycobacterial infection
Which accessory muscle can classically cause cubital tunnel syndrome?
Anconeus epitrochlearis
Which tendon is classically injured in lateral epicondylitis?
Extensor carpi radialis brevis
A SLAP tear involves the labrum at the insertion of which tendon?
Long head of biceps
Describe the features of the normal variant sublabral recess.
Incomplete attachment of the labrum at 12 o’clock which follows the contour of the glenoid and has smooth margins
Describe the features of the normal variant sublabral foramen.
Unattached (but present) portion of the labrum at the 1 o’clock to 3 o’clock positions (anterior/superior)
What is the Buford complex?
Absent anterior/ superior labrum (1-3 o’clock). Thickened middle glenohumeral ligament.
What is the mildest Bankart-type lesion?
Glenolabral articular disruption (GLAD)- superficial anterior inferior labral tear with associated cartilage damage
What is the difference between Perthes lesion and anterior labral periosteal sleeve avulsion (ALPSA)?
In Perthes the anterior labrum is avulsed but undisplaced whereas in ALPSA the labrum is displaced inferomedially. The inferior glenohumeral ligament remains attached to periosteum in Perthes but is displaced medially in ALPSA.
What is a Bankart lesion?
Disruption of the periosteum and torn labrum
Which ligament is avulsed in a humeral avulsion glenohumeral ligament (HAGL) injury?
Inferior glenohumeral ligament
A subscapularis tear can result in dislocation of what structure?
Medial dislocation of the long head of biceps
A cyst at the level of the suprascapular notch will affect which muscle(s)?
Supraspinatus and infraspinatus
A cyst at the level of the spinoglenoid notch will affect which muscle(s)?
Infraspinatus
Compression of the axillary nerve in the quadrilateral space will result in atrophy of which muscle?
Teres minor
What would you find at the superior border of the quadrilateral space?
Teres minor
What would you find at the inferior border of the quadrilateral space?
Teres major
What would you find at the lateral border of the quadrilateral space?
Humeral neck
What would you find at the medial border of the quadrilateral space?
Triceps
Sudden onset pain with profound weakness in 1-2 days in muscles affected by two or more nerve distributions (eg suprascapular and axillary) and no history of trauma. Diagnosis?
Parsonage-Turner syndrome
What is the primary stabiliser of the longitudinal arch of the foot?
Posterior tibial tendon
What is the most common soft tissue sarcoma in adults?
Pleomorphic undifferentiated sarcoma
Painful soft tissue mass in the lower extremity of a 20-40 year old which has soft tissue calcification and bony erosions.
Synovial sarcoma
What are the features of Mazabraud syndrome?
Polyostotic fibrous dysplasia.
Soft tissue myxomas.
What is Ollier’s syndrome?
Multiple enchondromas
What are the features of Maffuci’s syndrome?
Multiple enchondromas.
Haemangiomas.
Chondrosarcoma.
Other malignancies.
Plasmacytoma in a vertebral body has which classic appearance?
“mini-brain”
What is the name from osteochondromas which develop in epiphyses causing joint deformity?
Trevor disease
AKA dysplasia epiphysealis hemimelica
Gullwing appearance is seen in which joints and which condition?
DIP joints.
Erosive osteoarthritis.
What are the features of Felty syndrome?
Rheumatoid arthritis.
Splenomegaly.
Neutropenia.
Hooked osteophytes can be seen in which conditions?
CPPD.
Haemochromotosis.
Rugger Jersey spine is classically seen in which condition?
Hyperparathyroidism
Big bridging lateral osteophytes are classically seen in which condition?
Psoriatic arthritis
Patients with Jaccoud’s arthropathy (non-erosive arthropathy with ulnar deviation of the 2nd-5th fingers at the MCP joints) usually have a history of what?
Rheumatic fever
(also seen in association with SLE)
“Frond-like” deposition of fatty tissue in the supra-patellar bursa of the knee. Diagnosis?
Lipoma arborescens
What is the syndrome seen most commonly in young athletic males with repetitive shoulder movements where by there is compression and thrombosis of the subclavian vein as it enters the thorax?
Paget Schroetter syndrome
Which disease is characterised by bone pain, exophthalamus, retroperitoneal fibrosis, diabetes incipidus and dyspnoea?
Erdheim Chester disease
Oedema of flexor carpi ulnaris and ulnar nerve thickening suggests which diagnosis?
Cubital tunnel nerve entrapment
Posterior interosseous nerve entrapment can result in the atrophy of which muscle group?
Extensor muscles
Anomalous aconeous epitrochlearis muscle can result in entrapment of which nerve?
Ulnar nerve
(cubital tunnel syndrome)
The posterior interosseous nerve is a branch of what nerve?
Deep branch of the radial nerve in the forearm
Where is the most common site of posterior interosseous nerve entrapment?
Superficial head of the supinator muscle along the arcade of Frohse
Which arthropathy affects the shoulders, carpal bones and hips in a bilateral fashion with subchondral cysts, juxta-articular swelling and low-to-intermediate soft tissue within and around the joint?
Amyloid arthropathy
(typically associated with long-term renal dialysis)
What is the disease characterised by tendinosis of the proximal origin of the patella?
Sinding-Larsen’s disease
At what distance is the tibial tuberosity to trochlear groove distance abnormal and associated with transient patellar dislocation?
>20mm
What are the imaging features of haemophilic arthropathy?
Widening of the intercondylar notch
Flattening of the condylar surfaces
Squaring of the patella
Epiphyseal enlargement
Bowing of the tibia (tibia vara) with wedge-shaped or fragmented epiphysis, depressed/ beak-like protuberance of the metaphysis and metaphyseal-diaphyseal angle >11. Diagnosis?
Blount disease
What are the skeletal features of primary and secondary hyperparathyroidism?
Primary: Brown tumours, chondrocalcinosis
Secondary: osteosclerosis (Rugger-Jersey spine)
Both: subperiosteal bone resorption, soft tissue calcification
What are the features of vitamin C deficiency (Scurvy)?
Bleeding gums
Metaphyseal bony spurs (“Pelkan spurs”)
Sclerotic line around perimeter of the epiphysis secondary to osteopenia (Wimberger line)
Ground glass osteoporosis
Cortical thinning
What are the features of Milwaukee shoulder?
Degenerative change: loss of joint space, subchondral sclerosis/ cysts (not osteophytes)
Destruction of subchondral bone
Intra-articular loose bodies
Capsular calcification
Joint effusion
Complete rotator cuff tear
What are the features of Thalassaemia?
Widened diploic space
“Hair on end” appearance of the skull
Sparing of the occipital bone
Absent/ reduced pneumatisation of the paranasal sinuses (spares ethmoid)
Erlenmeyer flask deformity (also seen in Gaucher disease)
What are the features of a scapholunate dissociation and which view can be carried out to emphasise this?
Scapholunate joint > 3mm
Clenched fist view will worsen
What is the pattern of bone bruising in a pivot shift injury?
Postero-lateral tibial plateau and lateral femoral condyle
What is the pattern of bone bruising in a knee hyperextension injury?
Anterior tibial plateau and anterior femoral condyle
What is the pattern of knee bone bruising in a dashboard injury?
Anterior tibia
What is the pattern of knee bone bruising in a clip injury?
Lateral femoral condyle and lateral tibial plateau
Which ligament is commonly injured in a pivot shift injury to the knee?
ACL
Which ligament is commonly injured in a hyperextension injury to the knee?
ACL, PCL
Which ligament is commonly injured in a dashboard injury to the knee?
PCL
Which ligament is commonly injured in a clip injury to the knee?
MCL
Patient aged 20-40 with a painful soft tissue mass near the joint. This has soft tissue calcification, bone erosion and fluid-fluid levels. What is the diagnosis?
Synovial sarcoma
