Test 2 Flashcards
Presents as bilateral DJD with central joint erosions. Seen with what?
Gull wing
DJD/erosive OA
What is gull wing and what is it seen with?
Bilateral DJD with central joint erosions
-DJD/Erosive OA
Targets DIPs/PIPs and 1st MCP. see osteophytes, sclerosis, cystic changes, loss of joint space and misalignment
DJD
What is seen with DJD and what does it target
Target: DIP/PIP/1st MCP, weight bearing—spine, hips, knee, AC.
Osteophytes, sclerosis, cysts, decreased joint space-asymmetric, misalignment due to redistribution of forces and deformity
Herberdens nodes
DIP
Bouchard’s node
PIP
What is it called when degeneration is seen in first MTP joint along with stiffness and pain
Hallux rigidus
Hallux valgus
What is hallux rigidus. Seen with?
DJD of feet
Normal angle of first MTP. If more than then what?
15 degrees or less normal
More: hallux Valgus
1st/2nd intermetatarsal angle greater than ___ is consisten with?
9 degrees
Metarsus primus Varus
What is metatarsus primus varus
When 1st/2nd intermetatarsal angle is greater than 9 degrees
Bunions are measured via what angle. The larger the angle….?
Intermetatarsal angle…should be less than 9 degrees
Larger angle= larger bunion
Where is DJD usually NOT seen in the shoulder unless trauma?
GH joint
What joint of the shoulder is often involved with DJD
AC joint
What is buttressing. What is it seen with
Increased cortical thickening of the medial femoral neck seen with OA of iliofemoral articulation
What is a increased cortical thickening of medial femoral neck? Seen with?
Buttressing
OA of iliofemoral articulation
What represent synovial intrusion through cartilage tissues
Cysts
What is a large synovial intrusion through cartilage fissures known as
Geodes
What does kohlers line measure for
Acetabular protrusion/otto’s pelvis/protusio acetabuli
Alas for acetabular protrusions
Kohlers line recall
Ottos pelvis
Protrusio acetabuli
DDD allows what
Retrilithesis
Posterior joint arthrosis allows what
Anterior movement
Spondylosis deformans
Outer disc degeneration
Marked by osteophytes
Intervertebral chondrosis
Inner disc
Marked by decreased disc height
What is marked by decreased disc height (type of intervertebral disc disease)
Intervertebral chondrosis (inner disc)
What is marked by osteophytes (intervertebral disc disease)
Spondylosis deformans (outer disc) Degeneration of the annulus
What phenomenon is sometimes seen with DDD
Vacuum aka Knutson’s
What is intervertebral disc osteochondrosis
Primary degeneration of nucleus pulposis
- loss of disc height with minimal osteophytes
- knutson’s vacuum phenomenon
Aka for endplate sclerosis
Hemispherical sponylosclerosis
Modic changes
Dark T1/Bright T2
Inflammation (marrow edema/fluid)
Modic type 1
What represents inflammation on MRIs/Modic type 1
Dark T1/Bright T2
Modic changes
Bright T1 and T2
Fatty infiltrate
Modic Type 2
What modic changes are seen on MRI with fatty infiltrate
Bright T1 and T2
Modic Type 2
Modic change
Dark T1 and T2
Sclerosis
What modic changes are seen with sclerosis
Dark T1 and T2
Modic Type 1
Inflammation
Dark T1/Bright T2
Modic Type 2
Fatty infiltrate
Bright T1 and T2
Modic Type 3
Dark T1 and T2
Sclerosis
By saying modic—it means signal changes are due to what. If not, then what?
If changes due to DDD, if not due to infection/tumor etc
White cortex is “right” on what MR
T1
White CSF is “right” on what MR
T2
JDD-Juvenile Discogenic Disease
T-L scheuermann’s disease
What is the name of the lateral projection seen on a film in uncovertebral degeneration
Pseudofracture (black)
What happens to joints of Lusaka when they degenerate
Uncinate hypertrophy
Where is zygapophyseal degeneration MC
Lower lumbar
Middle cervical
Upper and middle thoracic
What does DDD look like on a T2 MR
Dark
Decreased signal
HADD MC affects what
Shoulder and hip
Supraspinatus tendon MC
What is pellegrini-Steida calcification
Calcification of medial tibial collateral ligament after injury
What is SOM (synovial osteochondrometaplasia)
Joint mice (usually many) with well-defined boarders seen in joints
What is known as apple core deformity
PVNS
Pigmented villonodcular synovitis
What is PVNS
Pigmented villonodular synovitis
Apple core deformity
Slow growing, benign, locally invasive tumor of synovium
Where is PVNS MC?
Knee, hip, elbow, ankle
What does a normal meniscus look like on MRI? Torn?
Dark triangle
Abnormal if have high signal intensity crossing meniscus
What is most common cause of neurotrophic arthropathy
Diabetes
6 D’s of neuropathic arthropathy
Distended (joint) Density increase Debris Dislocation Disorganization Destruction
Atrophied neurotrophic
MC form of Charcot
Presents as osteopathic process with complete bone resorption of ends
“Licked candy cane appearance”
DJD implies what
Degeneration of synovial articulation
MC areas of degeneration in spine
C5/C6
L4/L5
TR and TE on T1 and T2
T1: short, short
T2: long, long
What MR is best for water? Fat?
T2= water T1= fat
What is DISH?
Diffuse idiopathic skeletal hyperostosis/forestier’s diease/ankylosing hyperostosis
Characterized by ligament ossification/hyperostosis
What ligaments may DISH affect
MC ALL but may see in PLL
(Thick flowing
0
MC in thoracic. May see lower cervicals/upper lumbar
What is pannus
Abnormal layer of fibrovascular tissue
MC seronegative spondyloarthropathy
AS
aka Marie strumpells
AS affects what 100% of the time
SI joints bilateral and symmetric
What is romanus lesion and associate with what
Destruction of corner of vertebral body
AS
What is bamboo spine and associated with?
Multiple segments get ankylosed
AS
What is trolley track and dagger sign and what associated with
Trolley track: ossification of capsule, ligamentum flavum, and inter/supraspinous ligament
Dagger: ossification of inter/supraspinous ligament
AS
What is AS radio graphically similar to?
Enteropathic arthritis
What does psoriatic arthritis affect
Peripheral joints
SI
Spine
Hands: DIP/PIP
What is radisographially similar to psoriatic arthritis
Reactive arthritis
What is ray pattern seen with
Psoriatic arthritis
What is mouse ears and see with?
Marginal erosions
Psoriatic arthritis
What is pencil in cup and seen with?
Whittling of phalanx and erosion into articulate surface
Psoriatic arthritis
What seronegative arthropathy predominately involved lower extremity and is almost exclusive to males
Reactive arthritis
What joints are predominantly affected with reactive arthritis
Lower extremity MTP IP-foot Calcaneous Ankle Knee
Bilateral asymmetric
What is chondrocalcinosis and where MC
Ca++ in the joint Knee (menisci) Wrist MCP Pubic symphysis
Looks like DJD but in an unusual location
What looks like DJD but in an unusual location
CPPD
Where is CPPD most likely seen
1.Knee
Chondrocalcinosis in menisci
- Wrist
Calcification of triangular cartilage on ulnar meniscal triquetral joint
What is triad seen in hemochromatosis
Bronze colored skin
Cirrhosis of liver
Diabetes
What are seen in hemochromatossi
Hook osteophytes
What are hook osteophytes seen with and where
MCP
Hemochromatosis
Where does gout really like
1st MTP
What sign is seen with gout
“Overhanding edge/margin sign”
-periarticular erosions
What test results are seen with zero positives
Increased ESR
+ ANA
-HLA-B27
SLE
Scleroderma
Jaccoud’s
Test results with seronegatives
Increased ESR
-ANA
+HLA-B27
What does the term syndesmophyte imply?
Seronegative inflammatory disease
What is an intercalary ossicle and seen where
Anterior aspect of disc
Annulus degeneration
What is scheuermanns
Juvenile discogenic disease of 3 continuous vertebra with disc space narrowing, end plate narrowing
-schmorels nodes
DDX for acetabular protrusion
OA of hip
RA
Bone softening
Paget’s disease
**Kohler’s line
Acetabular protrustion significant if more than what in Males? Females?
3mm
6mm
Uncinate hypertrophy can give what finding on a lateral projection
Pseudofracture
Facets should have what normal appearance that is lost during facet arthrosis
Smooth “undulating” appearance
Signs of thoracic osteoarthritis
- Decreased discs in dorsal direction (posterior)
- ostophytes on the right and anterior
- sclerosis
IVD herniation in cervical. Midline and lateral hernation have what affects
Midline: myelopathies
Lateral: nerve root below ex: c5 disc affects c6 nerve
Lumbar disc hernation. Midline and foraminal cause what
Midline: nerve root below aka transversing NR
Foraminal: nerve root at same level
For both cervical and lumbosacral disc herniations the nerve root usually involved corresponds to?
The lower of the adjacent vertebra
On a T2, how is herniation seen/appear
High signal intensity usually refers to outer annulus
What is normal canal width in Cervicals and lumbar and where is it measured from
Posterior vertebral body to spinolaminar line
Cervicals: 12mm
Lumbar: 15mm
Anything less is classified as stenosis
Where is DJD of the knee Mc?
Medial tibiofemoral
Appearance of DDD on T2
Dark discs
Enthesopathic changes seen in what types of diseases
Degenerative and inflammatory
If cants distinguish between DISH/AS on cervical lateral X-ray what could you do?
Look at AP lumbar. If it’s AS. It MUST affect SI joints
Protrusion-herniation
Disc beyond interspace
Incomplete disruption of annulus
What does a high intensity signal on a T2 at the back of a disc indicate
Annular tear
What conditions involve acro-osteolysis (6)
Psoriasis Scleroderma (PSS) Injury Neuropathy HPT Hajdu-Cheney syndrome
Aka for pannus
Hyperplastic synovitis
Patient presents with juxta-articular hyperemia what disease is most likely associate with?
Rheumatoid arthritis
Neurotrophic arthropathy, Charcot joints, neuropathic joints are MC due to
Diabetes
Atrophied neurotrophic
MC form of Charcot
Osteolytic process that bone is completely resorted of ends of affected bones
Licked candy cane appearance
