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306 Cards in this Set
- Front
- Back
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M/c bone formation
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Enchondral Ossification
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Bone formed when mesenchyme condenses into highly vascular connective tissue
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Intramembranous Ossification
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Bone formation responsible for appositional growth of long bones
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Intramembranous Ossification
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Most metabollically active part of bone
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Metaphysis
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Is periosteum innervated?
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Yes
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2 ways joints are classified
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1) extent of joint motion and 2) type of articular histology
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Slightly moveable joints
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Amphiarthroses
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Freely moveable joints
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Diarthroses
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Fixed or rigid joints
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Synarthroses
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Best imaging of sutures
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CT
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Where majority of sutures are found
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Skull
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Adjacent bony surfaces are united by an interosseous ligament
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Syndesmosis
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Teeth ligaments
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Gomphoses
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Type of cartilage in symphisis
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Fibrocartilage
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Type of cartilage of intervertebral disc
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Fibrocartilage
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2 cartilaginous articulations
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symphyses and synchonrdoses
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Type of articulation of growth plate
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Synchondrosis
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Type of cartilage in synchondrosis
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Hyaline cartilage
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Part of synovial joint that secretes synovial fluid
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Synovial membrane
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Type of cartilage in synovial joint
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Hyaline cartilage
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T/F: Blood vessels found in synovial joint cartilage.
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True
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Hyaline cartilage thicker in small or large joints?
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Large
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Hyaline cartilage thicker in younger or older joints?
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Younger
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Hyaline cartilage thicker in more stressed or less stressed joints?
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More stressed
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What is more vascularized: capsule of joint or synovial membrane?
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Synovial membrane
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Capsule or synovial membrane is more innervated?
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Capsule
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Most of meniscus is vascular or avascular?
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Avascular
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Area of meniscus with blood and nerve supply?
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Peripheral zone
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DJD in hands is usually found in more proximal or distal joints?
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Distal
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Inflammatory arthritis is usually found in more proximal or distal joints?
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Proximal
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Purpose of labrum of joint
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Enlarge or deepen joint cavity
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Locations of labrum
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Hip and glenohumeral joints
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Acidic or alkaline pH of synovial fluid
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Alkaline
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Function of synovial fluid
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Lubrication and nutrition to articular cartilage
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Where synovial sheaths are found
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At sites where closely apposed structures move in relation to each other
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Enclosed, flattened sacs consisting of synovial fluid
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Bursae
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m/c joint of shoulder involved with DJD arthritis
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AC joint
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T/F: Tendons change length.
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False
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Attachment sites of tendons and ligaments
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Entheses
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Several flat layers/sheets of dense collagen fibers associated with attachment of a muscle
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Aponeuroses
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Type of fascia that fuses w/ periosteum when contacting bone
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Deep fascia
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Law that says nerve supply generally arises from the same nerves that supply the adjacent musculature
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Hilton's Law
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Xray of this structure requires a minimum of two views perpendicular to each other with at least one view clearly demonstrating the opposing articular surfaces
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Joints
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Gold standard imaging for evaluation of arthritis
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Plain film X-ray
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Radiolucent air is positive or negative contrast
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Negative
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Contrast study of spinal cord, nerve root and dura mater
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Myelography
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bajo
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low; short (stature)
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Hounsfield Unit for FAT
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-60
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Hounsfield Unit for WATER
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0
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Hounsfield Unit for CSF
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10
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Hounsfield Unit for BONE
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1000
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Imaging that uses Hounsfield Units(HU)
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Computed Tomography(CT)
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Imaging that uses radio frequency waves and hydrogen
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MRI
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Imaging associated with Tesla unit
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MRI
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Higher Tesla means better image or worse image
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Better
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Tattoos and pacemakers are contraindicated when using this imaging option
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MRI
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Imaging that emits gamma rays
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Nuclear Imaging aka Bone Scan
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Very sensitive imaging but not that specific for differential diagnosis
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Nuclear Imaging aka Bone Scan
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Dynamic tracer time sequence is a part of this imaging modality
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Nuclear Imaging aka Bone Scan
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Bone scans that can be reconstructed in multiple planes
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SPECT
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Imaging that visualizes blood flow and metabolism at the cellular level
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Positron emission tomography(PET)
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Imaging most useful in detection and tumor staging
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PET
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Relatively inexpensive, fast, safe, non-ionizing musculoskeletal diagnostic imaging
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Ultrasound
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Imaging that radiologis uses to diagnose and treat non-operatively
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Interventional Radiography
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Thermal destruction of nerve tissue using radio waves to treat chronic pain disorders
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Radiofrequency ablation
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Imaging that involves injecting contrast medium into an intervertebral disc
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Discography
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Imaging guided injection of methyl methacrylate into a vertebral body to relieve severe pain
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Percutaneous vertebroplasty
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Two common errors in report writing
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Errors in observation and interpretation
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ABCS stands for..
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Alignment, Bone, Cartilage spaces(joint spaces) and soft tissues
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B-Bone involves looking for what when report writing
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bone density, sclerosis, radiolucencies, fracture or destruction
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A-Alignment involves looking for what when report writing
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vertebral segmental translation, scoliosis or spondylolisthesis
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C-Cartilage spaces(joint spaces) involves looking for what when report writing
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1) Joint space width, 2) Subchondral bone erosions, 3) Epiphyses
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S-Soft tissues involves looking for what when report writing
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Muscles, Fat pads, joint capsules and periosteal reactions
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CATBITES stands for what?
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1) Congenital, 2) Arthritis, 3) Trauma, 4) Blood, 5) Infection/Inflammation, 6) Tumor, 7) Endocrine, 8) Soft-tissue
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T/F: The findings part of the radiology report does NOT include diagnoses.
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True
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T/F: Complete sentences must be written in writing radiology reports
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False
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Juvenile onset implies what age group
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Younger than 16 years old
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Greater than 1:80 RA factor titer is positive for which condition
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RA
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aka RA factor
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RA latex
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Serum protein seen in RA that is needed to fight infection
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C-Reactive Protein
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Screening test to detect antibodies seen in serum of RA patients
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RA Latex
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Serum screening test used to diagnose systemic lupus erythematosus(SLE)
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ANA titer
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Screening test used to diagnose diseases such as ankylosing spondylitis and/or juvenile rheumatoid arthritis
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HLA
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Anatomic term for transition zone between bone and ligament or tendon
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Enthesis
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Inflammatory cellular infiltrate at the bone-ligament or bone-tendon junction as seen in AS or periostitis.
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Enthesopathy
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Loss of bone due to pressure atrophy or active breakdown of bone tissue
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Erosion
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Single joint involvement
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Monoarticular
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2-4 joints involved in the disease process
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Pauciarticular
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> 4 joints involved in disease process
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Polyarticular
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When comparing one side of body with other, changes appear very similar
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Symmetric pattern of joint involvement
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Entire joint cavity is decreased due to complete loss of cartilage independent of stressed areas
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Uniform loss of joint space
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Localized decrease in joint cavity usually seen in degenerative arthritis
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Nonuniform loss of joint space
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Degenerative bony outgrowth continuous with the underlying cortex, covered by a cartilaginous cap, occuring at the insertion of a ligament
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Osteophyte
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Prolific osssification within a spinal ligament or tendon seen in DISH
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Hyperostosis
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Inflammatory ossification within a spinal ligament as seen in AS
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Syndesmophyte
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Degenerative spinal osteophyte
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Spondylophyte
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Inflammatory arthritis involving the spine
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Spondyloarthropathy
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Inflammatory arthritis that lacks the presence of rheumatoid factor(RF)
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Seronegative arthritis
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Inflammatory arthritis of the spine which lacks the presence of rheumatoid factor.
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Seronegative spondyloarthropathy
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4 types of seronegative spondyloarthropathy
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1) Psoriatic arthritis
2) Enteropathic arthritis 3) Anklyosing spondylitis 4) Reiter's syndrome |
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4 signs of Degenerative Arthritis
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1) Non-uniform loss of joint space
2) Bony overgrowth 3) Subchondral cysts 4) Sclerosis |
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Arthritis related to altered biomechanics
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Degenerative
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4 types of Degenerative Arthritis
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1) DJD/DDD
2) DISH 3) Synoviochondrometaplasia 4) Neuropathic Arthropathy(Syphillis/Diabetes) |
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Inflammation of synovium leading to pannus formation
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Inflammatory Arthritis
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Infl Arthritis Symmetry
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Symmetrical or Asymmetrical
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Uniform loss of joint space, bony erosions, articular deformity and juxta-articular osteoporosis are 4 signs of which arthritis
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Inflammatory
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RA, AS, Psoriatic Arthritis, SLE, Scleroderma and Still's Dz are all examples of which arthritis category?
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Inflammatory
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aka "Lumpy Bumpy" Bone Dz
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Metabolic/Crystal-induced arthritis
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Lumpy Bumpy arthritis is symmetric or asymmetric?
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Asymmetric
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Chondrocalcinosis is a sign of which arthritis?
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Metabolic
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Large soft-tissue masses are typical in this arthritis?
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Metabolic
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Large soft-tissue masses are typical in this arthritis?
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Metabolic
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Gout, CPPD and Hydroxyapatite Deposition Dz are examples of which arthritis?
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Metabolic
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Gout, CPPD and Hydroxyapatite Deposition Dz are examples of which arthritis?
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Metabolic
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aka Kellgren's Arthritis
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DJD
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aka Osteoarthritis
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DJD
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Primary cause of Degenerative Arthritis
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Unknown
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T/F: Primary causes are most common forms of degenerative arthritis
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False
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Secondary causes of degenerative arthritis?
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Trauma or altered biomechanics
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5 risk factors of DJD
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Age, Gender, Obesity, Trauma/Mechanical, and physical activity/overuse
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Degenerative Arthritis Gender/Location
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Males <45 yo
Females >45 yo |
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If DJD localized to one joint, what is the most common cause?
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Trauma/Mechanical
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T/F: Cardiovascular causes are possible for DJD.
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True
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DJD Onset
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Insidious
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Arthritis that gets worse with rest and improves with activity
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DJD aka Degenerative Arthritis
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Crepitus, Stiffness, Swelling and moderate pain associated with which arthritis?
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Degenerative or DJD
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Decreased temperature and barometric pressure are provocative to this arthritis.
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Degenerative
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T/F: Degenerative is only monoarticular.
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False
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AC joint and 1st metacarpotrapezium joint are a typical location in which arthritis
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Degenerative
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Alteration of ground substance of cartilage of the affected joint is a possible cause of this arthritis
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Degenerative
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Cause of hypertrophy of synovium in degenerative arthritis
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Cartilage debris
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Intrusion of synovial fluid into subchondral bone in degenerative arthritis form these 2 things.
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Osteophytes and subchondral cysts
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Aka spondylophytes
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Osteophytes
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Osteophytes that occur near insertion of tendon/ligament
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Enthesophytes
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aka eburnation
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Subchondral sclerosis
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Bony response to forces placed on a degenerative joint
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Eburnation
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aka geodes
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subchondral cysts
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T/F: Subchondral cysts are radioopaque on radiograph.
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False
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M/C location of geodes in skeleton
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Hip
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DJD can mimic this dz due to large geodes
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Cancer
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Calcified loose bodies in joint
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Joint Mice
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Remolding of subchondral bone to reshape articulation.
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Articular Deformity
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Migration or alignment of bone in joint due to ligament laxity.
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Joint Subluxation(not same as chiropractic subluxation)
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Bony nodes in PIPs seen in DJD
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Bouchard's nodes
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Bony nodes at DIPs seen in DJD
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Heberden's nodes
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T/F: Elbow is not a common location for DJD.
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True
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T/F: AC joint is not a common location for DJD.
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False
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aka Maxum coxae senilis
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Hip DJD
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Hip DJD age
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Elderly
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Osteophytes wrapping completely around femoral head
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"collar osteophyte"
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Buttressing or thickening of cortex is on the lateral, superior, inferior or medial side of femoral neck in DJD?
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Medial
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Joint deformity seen in DJD in which the femoral head is flattened and the acetabulum is remolded
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Tilt Deformity
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M/C form of hip migration in DJD
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Superior
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aka widened medial hip joint space
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Waldenstrom's Sign
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M/C form of hip migration seen in RA
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Axial
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Two forms of hip migration in which protrusio acetabuli may been seen
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Axial and Medial
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Name of lesion where the femur punctures acetabulum
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Protrusio acetabuli
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T/F: Lateral joint space is most common compartment affected in knee DJD.
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False (Medial)
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What happens to tibial eminences in knee DJD?
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Spiking
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Name of sign seen in patellar tendon degenerative arthritis.
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Patellar tooth sign
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Best imaging to see focal cartilage defects.
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MRI
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Prolonged sitting with knees bent causing chondromalacia patella.
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Movie theater sign
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Anteriomedial knee pain w/ crepitus, buckling, locking, stiffness, tenderness and pain when getting up describe the classical presentation of which knee dz?
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Chondromalacia patella
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T/F: Ankle mortise joint is common place for DJD.
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False
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If DJD seen in elbow or ankle, what should you suspect?
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Trauma
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Type of DJD @ hindfoot
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Enthesopathic
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T/F: 1st metatarsotarsal joint is not commonly seen with degenerative arthritis
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False
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M/C area of forefoot DJD
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1st metatarsophalangeal joint (MTP1)
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T/F: Osteoarthritis, osteoarthrosis and
DJD are appropriate to use when discussing disc degeneration. |
False
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Boards term for degenerative disc disease
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Spondylosis
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2 of the most reliable indicators of DDD are...
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1) Dec in disc height and 2) marginal osteophytes
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3 Diff Dx of osteophytes
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1) Paravertebral ossifications/calcifications, 2) Syndesmophytes, and 3) longitudinal ligament ossification
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T/F: Working hypothesis is that the facet joints degenerate first and then the disc degenerates.
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False (Disc degenerates first)
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3 stages of spinal degeneration
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1) Joint dysfunction, 2) Instability, 3) Stabilization
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T/F: 1st stage: Joint dysfunction involves more of the annulus fibrosus than the nucleus pulposus
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True
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T/F: 2nd stage of spinal degeneration: Instability involves more of the nucleus pulposus than the annulus fibrosus
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True
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Ligamentous laxity is part of which stage of spinal degeneration
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2 - Instability
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1st stage of spinal degeneration is associated with which age group?
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Young adults
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3rd stage of spinal degeneration typically is associated with which age group?
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>60
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Why is the 3rd stage of spinal degeneration called stabilization?
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Osteophyte proliferation and joint stiffening
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2 general subsets of DDD
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1) Spondylosis deformans and 2) IVOC
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Type of DDD in which annulus fibrosus is mostly responsible for disc degeneration.
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Spondylosis Deformans
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Annular tears typically occur where?
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At attachment sites of vertebral bodies
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Type of DDD in which nucleus pulposus is mostly responsible for disc degeneration.
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IVOC
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IVOC stands for?
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Intervertebral Osteochondrosis
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Type of DDD in which large spondylophytes are typical.
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Spondylosis Deformans
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M/C area of large spondylophytes in spondylosis deformans.
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Anterior and Lateral
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T/F: Posterior osteophytes are typical in spondylosis deformans.
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False- not common
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Diff Dx of IVOC
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Infection
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Diff Dx of Spondylosis Deformans
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DISH, AS and Psoriatic Arthritis
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Type of DDD in which there is marked loss of disc space.
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IVOC
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Vacuum cleft typical in this type of DDD
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IVOC
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2 typical signs in IVOC
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1) Nuclear vacuum cleft and 2) Endplate sclerosis
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M/C levels of C-Sp DDD
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C5/C6 and C6/C7
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Pseudofracture is a result of this development in cervical DDD.
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Uncovertebral arthrosis
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Facet and uncinate degeneration can lead to this which could cause nerve impingement.
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IVF encroachment
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How much cervical spondylolisthesis must be present before it is considered unstable?
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> 3mm
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Normal sagittal vertebral canal width
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12 mm
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T/F: Upper thoracics are m/c form of T-Sp DDD.
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False - Mid and Lower Thoracics
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Why are osteophytes generally larger on the right side of the thoracic vertebrae?
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Pulsation inhibition effect of aorta on left of vertebral bodies.
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Most narrow discs in spine are found where?
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T2-T4
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Name of syndrome in which DDD of costovertebral and costotransverse joints refer pain to lumbar spine.
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Maigne's syndrome
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Name of syndrome in which DDD of costovertebral or costotransverse joints involvement cause GI complaints.
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Robert's syndrome
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Large osteophytes in costovertebral or costotransverse joints mimicking a lung mass are called what?
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Coin lesions
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T/F: IVOC is more common than spondylosis deformans in lumbar spine.
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False - They are equally common.
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M/C level of DDD in lumbar spine.
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L4/L5 and L5/S1
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T/F: Degenerative spondylolisthesis is common in the lumbar spine.
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True
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M/C level of degenerative spondylolisthesis in lumbar spine
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L4/L5
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M/C level of degenerative spondylolisthesis in C-Sp
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1) C6 then 2) C5
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Can pt have an upper motor neuron lesion at L4/L5?
|
No. There is no cord present--Cauda Equina
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What portion of S/I joint is involved in DJD most commonly?
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Lower 2/3
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Causes of S/I DJD?
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1) Scoliosis
2) Leg deficiencies 3) Pelvic ring trauma |
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Where are osteophytes usually seen in S/I DJD?
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Inferior joint space
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Amt of joint space loss in S/I DJD?
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<2mm
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Type of "Modic Change" of DJD seen with edema
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Type I
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Type I Modic Change signal intensities on MRI
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T1 low; T2 high; T1 fs high (not sure this answer correct)
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Endplate sclerosis in Type I DJD is light/dark on MRI
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Dark
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Endplate sclerosis in Type II DJD is light/dark on MRI
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Light
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Modic Change Type associated w/ increased fat signal
|
Type II
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Type III DJD Diff Dx
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Infection or Metastasis
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Type III DJD MRI signal intensities
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All decreased
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Type II DJD MRI signal intensities
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T1 high; T2 low
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Extensive endplate sclerosis associated with long-standing degeneration is associated with which DJD Modic Change Type
|
Type III
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M/C location of Hemispherical Spondylosclerosis
|
L4/L5
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Name of dz that shows semicircular endplate to mid-body sclerosis.
|
Hemispherical Spondylosclerosis
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Hemispherical Spondylosclerosis associated w/ which type of modic change of DDD
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Type III
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Term used to describe annular tear area on MRI
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High-intensity zones
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Herniation of nucleus pulposus through cartilaginous endplate into vertebral marrow space.
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Schmorl Node
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M/C location of Schmorl Node
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T12-L1 area
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Cause of Schmorl Node
|
Developmental or post-traumatic
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Disc Lesions age and gender
|
25-45; male
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If looking at T2 MRI, and you see a dark annulus and a white nucleus, what should you suspect?
|
Healthy Disc - Normal
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How far does a normal disc project past the posterior endplate of a vertebra normally?
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≤ 1mm
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Annular bulge distance past endplate
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1-3mm
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Disc herniation that has an extension of the nucleus pulposus through a partial annular defect.
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Disc protrusion
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Disc herniation that has complete annular defect through which the nucleus pulposus migrates
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Disc extrusion
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Migration of a "free fragment" of herniated material that has no connecting bridge to the parent IVD.
|
Sequestration
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Top three ways sequestrations migrate
|
1) Laterally
2) Superiorly 3) Inferiorly |
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aka Soft Disc
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Herniation
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aka Hard Disc
|
Osteophytes off posterior endplate or uncinates
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Degenerative Spondylolisthesis is secondary to which pathology?
|
Facet joint degeneration
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What pathology can spondylolisthesis lead to?
|
Spinal canal stenosis and ligamentum flavum hypertrophy/buckling
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Deg. spondylolisthesis age
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Females >40
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Deg Spondylolisthesis location
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L4
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3 m/c areas for c-sp deg. spondylolisthesis
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1) C7/T1
2) Next segment up 3) Next segment up (C5/C6) |
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Baastrup's disease results from what secondary pathology
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IVD and posterior joint arthrosis
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Pseudoarthrosis of two or more spinous processes
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Baastrup's disease
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Hip impingement thought to lead to premature degeneration.
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Femoral Acetabular Impingement Syndrome
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2 types of Femoral Acetabular Impingement Syndrome(FAIS)
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Cam and Pincer types
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Cause of Cam FAIS
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Extensive hip flexion and internal hip rotation
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Pistol grip, Pitt's pits, deformity of femoral head/neck and os acetabuli are typical radiographic signs of this condtion.
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Cam FAIS
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Rounded radiolucencies seen at the superolateral femoral neck in Cam FAIS.
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Herniation pits aka Pitt's pits
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Epiphysis of pubis remains open after 18 years old
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Os Acetabuli
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Deformity of anteriorsuperior head/neck of femur in Cam FAIS
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"Pistol grip" deformity
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FAIS characterized by deep acetabular socket with localized overcoverage
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Pincer
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Figure 8 sign, Posterior Wall sign and protrusio acetabuli, acetabular rim ossification and posterior inferior cartilage damage is associated with which FAIS type
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Pincer
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aka Erosive Osteoarthritis
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Inflammatory Osteoarthritis
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EOA age/gender
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Female; 30-50
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Gull-wing sign found in what bone pathology?
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EOA
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Nonuniform loss of joint space, subchondral sclerosis and erosions are part of what pathology.
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EOA
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aka Forestier's Dz
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DISH
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Ankylosing hyperostosis of spine
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DISH
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Ossification of anterior longitudinal ligament is a hallmark in this pathology.
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DISH
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DISH age/gender
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Male; 40-60
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What do DISH and EOA have in common?
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Morning stiffness
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Bone pathology associated with dysphagia, flattening of T-Sp kyphosis and tendonitis
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DISH
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Cause of DISH
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Unknown
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Bone pathology associated with diabetes and increased HLA-B8
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DISH
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DISH must involve how many anterior vertebral bodies in order to diagnose it?
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4
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T/F: IVDs do not flatten out in DISH
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True
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M/C location of DISH in spine
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T-Sp
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M/C C-Sp location of DISH
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C3-C5
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M/C T-Sp location of DISH
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T7-T11
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M/C L-Sp location of DISH
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L1-L3
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4 Dx parameters for diagnosing DISH
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1) Flowing anterior calcification of ≥4 segments
2) Preservation of disc height w/o signs of DDD 3) Absence of facet ankylosis 4) Absence of S/I ankylosis or erosions |
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M/C location of extra-spinal DISH
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Pelvis, Patella, Calcaneus, Elbow
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If someone has an OPLL (ossification of PLL), can we as chiropractors adjust them?
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No.
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aka Japanese Disease
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OPLL
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OPLL location
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C3-C5(M/C), T4-T7, L1-L3
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Lumbar OPLL is associated with what % of DISH pts?
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50%
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OPLL age/gender
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Males; 40-70
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Intercalary bone indicates what pathology?
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Disc degeneration secondary to trauma
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M/C neurological problem associated w/ OPLL
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Cord signs--Motor and sensory disturbances in lower extremity.
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Motor and sensory disturbances associated w/ OPLL
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Ataxia, loss of coordination, numbness, DCML problems
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OPLL is enchondral or intramembranous ossification
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Enchondral-Cortical
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OPLL Plain film appearance
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Thin radiolucent zone between OPLL(1-5mm thick) and posterior vertebral body
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aka Synovial Osteochondromatosis
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Synoviochondrometaplasia
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SCM location
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Knee, hip, elbow
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SCM age/gender
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Males; 20-60
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SCM onset
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Insidious
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SCM s/s
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Low grade dull pain, dec ROM, swelling, crepitus, joint locking
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SCM plain film appearance
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Apple core deformity around femoral neck and loose calcified bodies 1-20 mm large.
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SCM Diff Dx
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PVNS, Chondrosarcoma, TB arthritis
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aka Charcot's joint
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Neuropathic Arthropathy
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M/C/c of Neuropathic Arthropathy
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Loss of joint proprioception secondary to Diabetes
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Neuropathic Arthropathy S/S
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Altered gait, loss of DTRs, painless joint effusion
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Neuropathic Arthropathy symmetrical/asymmetrical
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Asymmetrical
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Neuropathic Arthropathy plain film appearance
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Hypertrophy(6 D's) seen in weight-bearing joints(ie. "jigsaw vertebra" in spine) and atrophy seen in non-weight-bearing joints(ie "licked candy stick" in UE)
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6 D's of neuropathic joint
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1) Debris
2) Density 3) Destruction 4) Distention 5) Dislocation 6) Disorganization |
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Shoulder Neuropathic Arthropathy is usually secondary to what pathology?
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Syringomyelia
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M/C spinal location of Neuropathic Arthropathy.
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L-Sp
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M/C associated disorder in spinal Neuropathic Arthropathy
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Syphillis
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Which of 6 Ds are seen in a neuropathic knee joint?
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Debris, Density and Destruction
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M/C neuropathic joint in foot
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Subtalar Joint
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Jumbo
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Big; fat
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Thug magic
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Jason Radtke
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