Ortho eponyms/ word associations Flashcards
Brown tumour; osteitis fibrosa cystica
Hyperparathyroidism
Gallium scan - positive with _____
Infections
Arthritis with eye symptoms
Juvenile RA
Still’s disease
Juvenile idiopathic arthritis < 3 years old
Pauciarticular juvenile idiopathic arthritis
Chronic iridocyclitis (anterior uveitis)
Ankylosing spondylitis - test
Schober’s test
- Assesses amount of lumbar flexion: mark ~L5 vertebrae + 10cm above + 5cm below. Pt flexes forward and distance between marks re-measured (normal >5cm increase in distance)
Ankylosing spondylitis - DDx
Forestier’s disease
aka Diffuse idiopathic skeletal hyperostosis (DISH)
- Bony hardening of ligaments
Arthritis + urogenital/bowel infection
Reiter’s syndrome
Gout joint aspirate
Negatively birefringent crystals; monosodium urate
Pseudogout joint aspirate
Positively birefringent crystals
Achondroplasia - brain association
Macrocephaly
Rickets CXR sign
Rickety rosary - bone necklace
Looser’s zones
‘Pseudo-fractures’: incomplete stress fracture
Associated most frequently with osteomalacia and rickets
Paget’s disease complication
Osteosarcoma
Osteoporosis circumscripta [cranii]
Paget’s disease XR sign
- highly circumscribed (focal) lytic lesion of skull bone
Erlenmeyer flask deformity
Osteopetrosis, Gaucher disease
Ends of long bones shaped like erlenmeyer flasks
Onion skin layers
Ewing’s sarcoma
Osteosarcoma XR sign
Codman's triangle (periosteal reaction) Sunburst appearance (breakdown of the cortex)
Popcorn calcification
Chondrosarcoma XR sign
Lytic bone mets - primary source
Lung, kidney, thyroid
Sclerotic bone mets - primary source
Prostate, breast
Fibrous dysplasia - associated conditions
McCune-Albright, Mazabrauds syndrome
Bone abscess aka
Brodie’s abscess
Gibbus
Tuberculosis of the spine
- structural kyphosis deformity of thoracic/ lumbar spine where one or more adjacent vertebrae become wedged
Mercedes Benz sign
Describes appearance of normal lateral shoulder X-ray
If glenoid and humeral head are imperfectly overlapping -> shoulder dislocation
Impingement syndrome - tests
Neers, Hawkins-Kennedy, Gerber’s lift-off, Jobe’s empty can
Rotator cuff tear - test
Positive arm-drop test
Shoulder instability + trauma
Bankart lesion
- lesion of anterior-inferior part of glenoid labrum, due to shoulder injury most commonly ant dislocation
SLAP lesion - test
O’Briens (active compression test)
- shoulder flex to 90, adducted 10-15, elbow straight
- painful elevation against resistance internally rotated, NOT externally rotated
Bicipital tendinitis - tests
Speed’s
Yergason’s
Speed’s = elbow extended, forearm supinated, shoulder slightly flexed - examiner applies manual resistance in downward direction
Yergason’s = elbow 90 degrees flexed then active supination and ext rotation against resistance.
Both are positive if pain is reproduced in area of bicipital tendon/ groove
Gilliatt-Sumner hand (wasting at base of thumb) - cause?
Neurogenic Thoracic outlet syndrome
Due to compression of lower brachial plexus. Characterised by wasting of AbPB, interrosoues and AbDM muscles PLUS normal sensation within region innervated by the median nerve. If a sensory abnormality does exist, it is usually of the medial forearm (not supplied by median n.)
Thoracic outlet syndrome - tests
Adson’s, Wright’s (hyperabduction)
Sprengel’s shoulder - association
Klippel-Feil syndrome
(‘cervical vertebral fusion syndrome’: rare congenital syndrome characterised by fusion of any C vertebrae)
Sprengel’s deformity is a rare congenital skeletal deformity where 1 scapula sits higher than the other
Lateral epicondylitis - test
Cozen’s test
- pain on resisted wrist extension
Maudsley’s
- pain on resisted middle finger extension
Gunstock deformity
Cubitus varus
Cubital tunnel syndrome
Pressure or stretching of ulnar nerve (‘funny bone’)
Ligament of Osbourne (roof of cubital tunnel)
Signs
- Ulnar claw
- Ulnar escape (Wartenberg’s sign: involuntary abduction of 5th finger due to unopposed action of EDM)
Tests
- Froment’s test (pinch grip holding piece of paper between index finger and thumb)
- Tinel’s test (over cubital tunnel)
Posterior interosseous nerve entrapment (arm)
Ligament (‘arcade’) of Frohse (also known as supinator arch: fibrous arch at superior layer of supinator muscle, under which the post interosseous nerve runs under and can become compressed)
Motor signs only (no sensory deficit) - weakness of wrist, thumb and finger extension
The post interosseous nerve is a continuation of the deep branch of the radial nerve once it penetrates the supinator muscle
Musculocutaneous nerve entrapment - presentation
Lateral forearm numbness
Due to compression by biceps tendon/ aponeurosis against brachialis fascia. This is quite distal, therefore only affects the lateral cutaneous branch, a purely sensory nerve for antero-lateral forearm
High median nerve/anterior interosseous nerve palsy
Positive O test
Hand of benediction
Median nerve trapped between two heads of pronator teres in proximal forearm
Carpal tunnel syndrome - tests/signs
Phalen's test Tinel's test ? negative O sign ? negative hand of benediction - for differentiated from proximal median nerve palsy
Ulnar nerve entrapment (ulnar tunnel syndrome)
Compression of ulnar nerve at wrist in Guyon's canal May be pure motor, pure sensory or mixed - Ulnar claw - weak grasp, pinch - pain /paraesthesia in ulnar 2 digits
Brodie Abscess
Subacute osteomyelitis
on XR: small oval cavity surrounded by sclerotic bone
‘Cold abscess’
Tuberculosis spread along fascial planes
De Quervain’s tenosynovitis - test
Finkelstein’s
Ollier’s disease
Multiple enchondromata affecting long bones
Kienbock’s disease
AVN, osteochondritis of lunate
RA deformities of the hand
Duck-bill deformity of the thumb Ulnar deviation of the fingers Radial deviation of carpus and metacarpals Volar subluxation of MPJ and wrist Boutonniere or swan-neck deformity
Hip OA - tests
Thomas’ test
Trendelenburg’s sign
Reduced ROM - internal rotation is first to go
AVN of femoral head - eponymous causes
Perthes
Tom Smith’s arthritis (septic hip arthritis in infancy causing pseudoarthrosis with hip subluxation)
Caisson’s disease (diver’s bends)
Gaucher’s disease (enzyme deficiency -> glucocerebroside accumulation)
Sandwich vertebral body
Osteopetrosis (dense bands involving both endplates of vertebral bodies are sharply demarcated)
DDH - XR sign
Broken Shenton’s line
Meralgia paraesthetic
Entrapment of lateral cutaneous nerve as it passes inguinal ligament
Presents with numbness over anterolateral aspect of the thigh from groin to knee
DDH - tests
Barlow’s, Ortolani’s tests
Galeazzi sign
Trendelenburg (if old enough to walk)
Klein’s line (XR)
Drawn along the top (lateral edge) of the femoral neck - normally, should continue through femoral head/ epiphysis, 20% existing above the line
If not, suggests SUFE
SUFE - tests/signs
Antalgic gait
Trendelenburg positive
Whitman’s sign (with hip flexion, there is obligate ER)
Femoroacetabular impingement
Pincer impingement (on acetabulum) Cam impingement (on femoral head) 70% have both
Sever’s condition
Osteochondritis of Achilles’ tendon insertion
- ‘traction apophysistis’
Kohler’s condition
Osteochondritis (AVN) of navicular bone
- self-limiting
Freiberg’s condition
Osteochondritis (AVN) of second metatarsal head
Ledderhose disease
Plantar fibromatosis (benign tumour of plantar fascia, similar process to dupuytren’s contractures)
> other similar processes = Garrod’s pads (dorsal IPJ), Peyronie’s disease (penis)
Fabella
Sesamoid bone in the head of gastrocnemius
Osgood Schlatter’s disease
Osteochondrosis/traction apophysitis of tibial tuberosity
Discoid meniscus
Congenital condition in which lateral meniscus bilaterally D-shaped (rather than usual C-shaped)
-> more prone to injury
Ankle mortise XR - angle, benefit
15 degrees internal rotation; gives true view of talus in tibiotalar joint
Patellofemoral syndrome (chondromalacia patella) - eponymous sign
Clark’s sign - inability to contract quadriceps against resistance, when the knee is held in extension
Blount’s disease
Physeal defect resulting in abnormal growth of inner part of upper tibia
- tibia goes into varus deformity
Friedreich’s ataxia
Also known as ‘Spinocerebellar degeneration’
Progressive genetic condition with difficulty walking, lost sensation in arms and legs, and impaired speech
Associated with pes cavus feet and equinovarus deformity
Ligamentous laxity score
Beighton score
RA - foot clinical presentation
Metatarsal heads prominent in sole
Toes clawed and dorsally dislocated
Congenital talipes equinovarus - eponymous treatment
Ponseti casting - repeated manipulation and adhesive strapping or PoP casting
Claw vs Hammer toes
Claw: proximal to distal - hyperextension MTPJ, flexion IPJs (both proximal and distal)
Hammer: proximal to distal - hyperextension MTPJ, flexion PIPJ, hyperextension DIPJ
Bunion
Hallux valgus deformity of MPJ of big toe
Part congenital, part acquired. Possibly higher risk from wearing tight/ pointed shoes
Morton’s neuroma - test
Mulder’s test - compression of MT heads and dorsal pressure under MT heads reproduces the pain
[Morton’s neuroma is a thickening of tissue around the digital nerve leading to the toes - most frequently bw the 3rd and 4th toes, usually in response to irritation, trauma or excessive pressure]
Ingrown toenail - eponymous surgery
Zadik’s operation
Pes cavus - areas of high friction
Callosities (plantar aspect)
Corns (dorsal aspect)
Bunionette
Exostosis on lateral aspect of MT5 (little toe)
E.g. from sitting cross-legged on a hard surface
‘Pepper pot skull’
‘Swiss cheese’ bones
Multiple myeloma
Levels of entrapment - straight leg raise vs femoral stretch test
SLR: L5-S1 nerve root
FST: L3-L4 nerve root
Lasegue’s test
After straight leg raise, lower leg until pain abates, then dorsiflex ankle +/- neck flexion
Positive (pain): dural involvement and/or sciatic nerve irritation
Negative (no pain): hamstring tightness or sacroiliac pathology
Winking owl sign (XR)
On AP view - absent pedicle is closed eye, open eye is other pedicle, beak is spinous process
Destroyed pedicle e.g. from tumour invasion
Froment’s sign
Test for ulnar nerve palsy
Spinal cord finishes at level of ?
L1-L2
Diffuse idiopathic skeletal hyperostosis (DISH syndrome)
Aka Forrestier’s disease or ankylosing spondylitis
Spondyloarthritis characterised by ankylosis and ossification of ligaments of 4 or more vertebrae
Spinal tuberculosis usually localises where?
Anterior longitudinal ligament of vertebral body
Scheuermanns disease = ?
Idiopathic juvenile kyphosis
- crushing osteochondritis affecting the spine in adolescence
The vertebrae grow unevenly with respect to the sagittal plane (the posterior angle is often greater than the anterior) -> “wedging” shape of the vertebrae, causing kyphosis
Pars interarticularis fracture - XR sign
Scottie dog sign
Risser sign
Indirect measure of skeletal maturity, whereby the degree of ossification of the iliac apophysis by x-ray evaluation is used to judge overall skeletal development
The lower the grade, the more severe the potential for spinal scoliosis
What is diastematomyelia?
Bifurcation of spinal canal/cord by bony, fibrous cartilagenous band
What is an Arnold-Chiari malformation?
Condition present at birth where there is skull abnormalities/ hypertrophy of cerebellar tonsils that herniate into the spinal canal and may obstruct the foramen magnum
Congenital scoliosis associated with ?
Renal, cardiac, imperforate anus, tracheoesophageal fistula, club hand, spinal dysraphism , VATER syndrome (aka VACTERL association - a group of birth deformities that tend to co-occur: vertebral , anorectal, cardiovascular, tracheoesopagheal fistula, esophageal atresia, renal, limb)
Scoliosis - test
Adams forward bend test
Schmorl’s nodes = ?
An upward and downward protrusion (pushing into) of a spinal disk’s soft tissue into the bony tissue of the adjacent vertebrae
Which side of a greenstick fracture cracks?
Convex side
What is the type of fracture when bone fragments are pulled in opposite direction?
Distracted
Abx for open fracture?
Ampicillin + flucloxacillin
Gentamycin/metronidazole if contaminated
Salter Harris II - XR sign
Thurston-Holland sign/fragment - sign depicting a triangular portion of the metaphysis remaining with the epiphysis in a physeal fracture
Salter Harris IV - beware the ? fracture
Triplane fracture - distal tibia fracture occurring in adolescents, that can appear as SH II and SH III in different imaging planes - combined SH IV, but need to look at multiple planes
Treatment of Salter Harris fractures
SH I and II - closed reduction and cast immobilisation
SH III and IV - ORIF
SH V - growth arrest almost inevitable, so no specific treatment
AVN XR sign
Crescent sign - subchondral lucent line
Reflex sympathetic dystrophy
Aka Sudeck’s dystrophy, complex regional pain syndrome type 1
Chronic arm or leg pain developing after injury, surgery, stroke or heart attack
Complex regional pain syndrome classification
Type 1: CRPS without evidence of nerve damage in the affected limb. Secondary to injury/trauma. This accounts for about 90% of CRPS.
Type 2: CRPS with evidence of nerve damage in the affected limb.
Fat embolus syndrome
ARDS associated with circulation of abnormal lipid aggregations
Sulcus test
Pulling arm downwards may cause depression below the shoulder
Suggestive of capsular instability
Kocher or Stimson method
For relocation of shoulder dislocation
Dugas sign
Unable to put hand on opposite shoulder with elbow touching chest - loss of internal rotation
Indicative of anterior dislocation of humeral head
Regimental badge/patch sign
Axillary nerve damage causes loss of sensation on lateral deltoid
Most common complication of anterior shoulder dislocation
Axillary nerve damage
Associated lesions with anterior shoulder dislocation
Hill-Sachs - indentation of posterior humeral head after impaction on glenoid rim
Bankart - avulsion of capsule when shoulder dislocates, seen in 85% of all anterior dislocations
Anterior shoulder dislocation - reduction methods
Kocher method
Hippocratic method
Stimson Hanging arm method
Putti-Platt operation
Operation for reduction of anterior shoulder dislocation - anterior joint reinforced by shortening subscapularis tendon to limit external rotation
Posterior shoulder dislocation - XR signs
Round light-bulb appearance of humeral head on lateral view
Reverse Hill-Sachs - divot in anterior humeral head
Erb’s palsy
Upper brachial plexus injury, affecting C5-C6; axillary, suprascapular and musculocutaneous nerves
Erb’s palsy - clinical sign
Waiter’s tip hands
Klumpke’s palsy
Lower brachial plexus injury, affecting C8-T1; ulnar and median nerves
Medication for heterotopic ossification prophylaxis
Indomethacin
Supracondylar fracture - XR sign
Fat pad sign (sail sign) - dark triangle posterior that may suggest blood in the joint, and demonstrates a minimal/undisplaced occult fracture
- fat pad sign anteriorly is normal
Tardy ulnar nerve palsy
Chronic clinical condition characterized by a delayed onset ulnar neuropathy after an injury to the elbow
- Typically, tardy ulnar nerve palsy occurs as a consequence of nonunion of pediatric lateral condyle fractures at the elbow, which eventually lead to a cubitus valgus deformity
Radial head fracture classification system
Mason classification
Essex Lopresti injury
Triad of comminuted fracture of radial head, disrupted interosseous membrane and distal radioulnar joint dislocation
Nightstick fracture
Isolated fracture of the ulnar shaft
Monteggia vs Galeazzi fractures
Monteggia: fracture of proximal ulna with dislocation of radial head
- A = proximal
Galeazzi: fracture of distal radius with dislocation of distal radioulnar joint
- Z = distal
MUGGER
- MU = Monteggia/ulna
- GR = Galeazzi/radial
Scaphoid test
Pain worse on radial deviation of wrist
- indicative of scaphoid fracture
Colles fracture
Distal radial fracture +/- fracture of ulnar styloid
‘Dinner fork deformity’
Dorsal (posterior) displacement of distal radial fragment
Complication = rupture of EPL tendon at Lister’s tubercle of the radius
Smith fracture
Distal radius fracture - volar displacement
Barton fracture
Intra-articular fracture of distal radius from shearing force
Bennett’s fracture
Fracture of thumb base (intraarticular @ CMCJ)
Proximal base is displaced proximally and radially
Rolando’s fracture
Three-piece intraarticular fracture of the base of the thumb
Gamekeeper’s thumb / skier’s thumb
An insufficiency of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb
Scapho-lunate dissociation - XR sign
An increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT)
Boxer’s fracture
Fracture of 5th metacarpal neck
Pilon fracture (of the hand)
Avulsion fracture involving the base of the most distal phalanx, which may secondarily result from a more proximal dislocation
Straddle fracture
Pelvic fracture where direct anterior blow causes fracturing and posterior displacement of all 4 rami
Pelvic fracture - classification system
Tile classification
Pelvic open book fracture is Tile classification Type ?
Type B
Leg appearance in posterior vs anterior hip dislocation?
Posterior: flexed, internally rotated, adducted (shortened)
Anterior: extended, externally rotated, abducted
Intertrochanteric hip fracture stability determined by compromise of ?
Calcar femorale
Thomas splint
Splint used for femoral diaphysis fractures
O’Donahue’s unhappy triad
ACL, ML and medial meniscus tear
Segond fracture
Avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently (~75% of cases) associated with disruption of the anterior cruciate ligament (ACL)
Lateral capsular sign (knee XR sign)
Indicative of Segond fracture, and therefore ACL disruption
Pellegrini-Stieda syndrome
The Pellegrini–Stieda sign is a calcification of the medial collateral ligament of the knee after trauma
Syndrome - above calcification with discomfort at MCL attachment to medial femoral condyle
Tibial plateau fracture classification system
Schatzker classification
Ankle fracture classification system
Weber classification
Maisonneuve fracture
Proximal fibula fracture together with unstable ankle injury
ATFL injury tests
Anterior drawer test
Talar tilt test (also CFL)
Talar fracture classification system
Hawkins classification
Hawkins XR sign (ankle)
Seen on AP view
Positive if subchondral lucency of talus is present at tibiotalar joint, which suggests intact vascularity and therefore decreased risk of osteonecrosis
- Positive here is good
If subchondral sclerosis, at risk of AVN
Bohler’s angle (XR sign)
Two lines formed from the three superior articular surfaces of the calcaneus should create an angle between 20-40 degrees - in calcaneal fracture, <20
Lisfranc ligament
Plantar ligament spanning articulation of medial cuneiform and second metatarsal base
Thomspons/Simmonds test
When patient lies prone, squeezing the calf should normally cause passive plantarflexion -> absence = positive test
Indicative of Achilles tendon rupture
Jones fracture
Fracture of midshaft of fifth metatarsal, from stress
Hangman’s fracture
Fracture of C2 with bilateral pars fractures, due to extension
March fracture
Stress fracture of distal metatarsal bone(s)
Cobb’s angle
Measure of scoliosis (if ≥10 degrees)
Frohlich syndrome
Hypopituitarism - delayed skeletal maturation, adiposity and hypogonadism
Lorain syndrome
Hypopituitarism - child fails to grow but normal body proportions
Albers-Schönberg disease / marble bones =
Osteopetrosis
Gaucher disease is _____
an auto rec genetic disorder in which glucocerebroside (a sphingolipid, also known as glucosylceramide) accumulates in cells and certain organs
Most common lysosomal storage disorder
Adson’s test / Wright’s test
For thoracic outlet syndrome
Adson’s: patient extends neck and turns towards affected side while breathing in deeply -> this compresses interscalene space and may cause paraesthesia and obliteration of radial pulse
Wright’s test: arms abducted and externally rotated -> reproduces Sx and pulse disappears on affected side
