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267 Cards in this Set
- Front
- Back
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ABCD of arthritis
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alignment
bone integrity cartilage/joint space distribution soft tissue changes |
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Subluxation
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RA
OA Lupus Jaccouds |
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Dislocation
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Neuropathic
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Reducible vs Fixed
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SLE-nonrerosive arthopathy with reducible subluxation
jaccouds-post RA |
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SLE
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radiographic changes uncommon
nonspecific soft tissue swelling nonerosive reducible subluxation calcification osteoporosis acrosclerosis or acroosteolysis |
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Bone integrity
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minerliazation
destruction erosion sclerosis new bone production |
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cartilage/joint space
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normal width
gout pvns primary synovial chondromatosis sle tb-phemisters triad uniform narrowing inflammatory infectious nonuniform narrowing oa neuropathic cppd |
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distribution
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joints involved
location in join proximal distal sporadic symmetric |
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bone destruction
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gout
infection sarcoid metastases |
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dip and pip arthoprathy
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no erosions
oa cppd erosions erosive oa psoariasis multicentric histiocytosis gout ra- pips only |
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axial narrowing of the hip
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rheumatoid arthritis
jia cppd ankylosing spondylitis infection |
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Humeral head absence
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syringomyelia
infection osteonecrosis |
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sacroiliitis
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as
ibd psoriatic arthritis reactive arthritis progression iliac side prior to sacral side findings widening erosions narrowing <2mm sclerosis ankylosis |
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soft tissue swelling
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fusiform
RA diffuse psoriatic lumpy-bumpy gout sarcoid amyloid multicentric histiocytosis |
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acroosteolysis
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collagen vascular disease
raynauds psoriatic arthritis hyperparathyroidism frostbite (spares thumb) polyvinyl chloride lesch-nyhan hajdu-cheney |
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soft tissue calcification
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HADD
CPPD Gout Collagen vascular disease renal osteodystrophy tumoral calcinosis |
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bone marrow edema pattern
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transient osteoporosis-see osteopenia with normal jt space, goes away
transient bone marrow edema syndrome-abnormality only seen on mr, not radiograph, goes away avn stress fracture trauma osteoid osteoma-esp if less than 30, ct or bone scan shows nidus, can give osteopenic appearance infection infiltrative neoplasm |
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generalized osteopenia
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osteoporosis
osteomalacia hyperparathyroidism neoplasm-multiple myeloma |
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localized osteoporosis
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disuse
reflex sympathetic dystrophy transient regional OP transion op of the hip |
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diff dx of scurvy
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TORCH INFECTION
neuroblastoma medication methotrexate |
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malignant bone tumors by age
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up to age 10
ewings osa leukemia, lymphoma 10-20 osa ewings leukemia, lymphoma 20-30 osa lymphoma ewings mfh over 30 myeloma metastases lymphoma chondrosarcoma mfh, fibrosarcoma osa |
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bubbly lesions of bone
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FEGNOMASHIC
fibrous dysplasia, fibrous coritcal defect EG, enchondroma GCT NOF Osteoblastoma myeloma, mets abc (always eccentric) simple unilocular cyst (always eccentric) hyperparathyroidis, hemophilia infection chondroblastoma |
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lytic epiphyseal lesions
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tumor
GCT EG Chondroblastoma Mets Infection Osetomyelitis TB Subchondral cyst Arthopathy (Cppd, oa, ra, hemophilia) Intraosseous ganglion |
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sclerotic metastases
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prostate
breast hodgkins other primaries carcinoid medulloblastoma bladder lung |
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permeative lesion in children
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round cell tumors
infection eg osa |
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permeative lesion in adults
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mets
multiple myeloma leukemia, lymphoma fibrosarcoma |
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bony sequestrum
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osteomyelitis
EG fibrosarcoma osteoid osteoma |
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malignant transformation of bony lesions
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fibrous dysplasia-fibrosarcoma, osa, mfh
pagets-osa>chondrosarcoma, fibrosarcoma, mfh, lymphoma osteomyelitis with draining sinus-scc radiation-osa, chondrosarcoma, mfh bone infarct-fibrosarcoma, mfh olliers disease-chondrosarcoma maffuccis-chondrosarcoma hereditary osteochondromatosis-chondrosarcoma |
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focal sclerotic lesion- TIC MTV
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Tumor
benign osteoma osteoid osteoma/osteoblastoma enchondroma fibrous dysplasia healing lesions-nof, eg, brown tumor malignant metastasis sarcoma lympohoma, leukemia any healing tumor (eg, brown tumor, tx mets) infection osteomyelitis sequestration sclerosing osteomyelitis of Garre Congenital bone island melorheostosis fibrous dysplasia metabolic paget's trauma stress fracture healing fracture vascular osteonecrosis bone infarct |
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osteonecrosis
ASEPTIC |
anemias (hereditary)
steroids ethanol pancreatitis, pregnancy trauma idiopathic caisson disease collagen vascular disease |
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ulnar and volar subluxation of metacarpals
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jaccoud's arthrophathy
sle rh fever scleroderma |
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periarticular osteopenia
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rheumatoid arthritis
scleroderma hemophilia osteomyelitis |
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subchondral cysts
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normal bone density
djd cppd seronegative spondyloarthropathies gout pvns synovial osteochondromatosis neuropathic joint abnormal bone density any of above ra avn |
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acroosteolysis
PINCH FO |
psoriasis
injury (thermal burn, frost bite) neuropathy congenital insensitivity to pain dm leprosy myelomeningocele collagen vascular disease scleroderma raynaud's disease hyperparathyroidism familial (hadju cheney) other Polyvinyl chloride snake, scorpion venom |
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new bone formation in arthritis
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periosteal new bone formation
psoriasis reiter's syndrome osteophytes oa cppd |
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calcifications and arthropathy
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periarticular
scleroderma sle (uncommon) articular cppd chondrocalcinosis joint space related neuropathic arthropathy synovial osteochondromatosis osteochondritis dissecans osteochondral fracture |
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chondrocalcinosis
HOGWASH |
hyperparathyroidism
ochronosis gout wilson's disease arthritides (any cppd hemochromatosis |
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soft tissue swelling in arthritis
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symmetric bilatera
ra any inflammatory arthr. asymmetric swelling one digit (sausage digit) psoriasisi reiters lumpy bumpy gout amyloidosis multicentric reticulohistiocytosis sarcoid |
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arthritis, distal and proximal IP joints
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oa
psoriasis reiter's multicentric histiocytosis |
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arthritis, proximal (MCP, carpus)
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RA
CPPD Hemochromatosis wilson's disease |
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arthritis, ulnar styloid
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RA
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monoarticular arthritis
CHRIST |
crystal arthropathies
hemophilia RA (atypical) infection synovial pvns synovial osteochond. trauma |
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neuropathic joint
|
common
dm spinal cord injury myelomeningocele, syringomyelia alcohol abuse uncommon syphyilis (tabes dorsalis) congenital indifference to pain neuropathies amyloidosis |
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behcet's
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arthritis, orogenital ulcers, iritis, large artery, aneurysms, cns arteritis
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reiters disease
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arthritis, urethritis, conjunctivitis
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still's disease
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juvenile RA, hepatosplenomegaly, lymphadenopathy
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felty's syndrome
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ra, splenomegaly, neutropenia
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jaccoud's disease
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arthritis following repeated episodes of rheumatic fever
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CREST
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calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia
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phemister triad (TB arthritis)
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osteoporosis, marginal erosions, slow cartilage destruction
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atlantoaxial subluxation
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ra, jra
seronegative spondyloarth. SLE down syndrome morquio's sydnrome trauma |
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diffuse osteosclerosis
DENSE BONES |
Tumor
mets lymphoma leukemia myelofibrosis mastcytosis congenital osteopetrosis pyknodysostis craniotubular dysplasias sickle cell anemia physiological newborn metabolic paget's renal osteodystrophy fluorosis hypervitaminosis A and D |
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diffuse osteosclerosis
3Ms PROOF |
mets
myelofibrosis mastocytosis sickle cell anemia pyknodysostosis, pagets renal osteodystrophy osteopetrosis others (dysplasias, hypothyroidism) fluorosis |
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localized osteopenia
look for insufficiency fracture |
disuse
arthrtitis sudek's atrophy, rsd paget's (lytic phase) transient osteoporosis of the hip regional migratory |
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diffuse osteopenia
|
primary osteoporosis
secondary osteoporosis endocrine disease nutritional deficiencies hereditary metabolic and collagen disorders medications osteomalacia nutricional deficiencies abnormal vit d metabolism gi absorption disorders renal disease medications HPT marrow replacement malignancy (ie myeloma) marrow hyperplasia (ie hemoglobinopathy) lysosomal storage diseases (Gauchers disease) |
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Multiple sclerotic lesions
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tumor
mets lymphoma/leukemia osteomatosis (gardner's syndrome) healing lesions sclerotic myeloma (rare) congenital fibrous dysplasia osteopoikilosis tuberous sclerosis mastocytosis metabolic paget's disease trauma healing fractures vascular bone infarcts |
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asymmetric periosteal reaction
|
tumor
infection (osteo, soft tissue, cogenital) inflammation (psoriatic, reiters, jra) trauma (fractures) vascular (subperiosteal hemorrhage |
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symmetric periosteal reaction in adults
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vascular insufficiency (venous>arterial)
hypertrophic pulmonary osteoarthropathy pachydermoperiostosis fluorosis thyroid acrophathy |
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|
hypertrophic pulmonary osteoarthropathy
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intrathoracic tumor
bronchogenic ca benign fibrous tumor of pleura mets mesothelioma chronic pulmonary infection bronchiectasis, abscess other entities occasionally show periosteal bone formation, but are more commonly associated with clubbing inflammatory bowel disease (UC, chrohns) dysentery cirrhosis cyanotic heart disease |
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solitary lytic skull lesion
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tumors
mets mm eg epidermoid hemangioma infections/inflammation osteo (tb, syphyllis) sarcoidosis congenital fibrous dysplasiam encephalocele metabolic paget's hyperthyroidism trauma leptomeningeal cyst |
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diffuse skull lesions
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sickel cell and thallassemia
HPT (salt and pepper skull) paget's (cotton wool) fibrous dysplasia (predominantly outer table) tuberous sclerosis (increased density of both tables) |
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multiple lytic skull lesions
POEMS |
paget's
parathyroid elevation osteomyelitis eg mets myeloma sarcoidosis |
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basilar invagination
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congenital
osteogenisis imperfecta kilppel feil syndrome achondroplasia chiari malformation cleidocranial dysplasia aquired bone softening paget's hpt osteomalacia, rickets |
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abnormal vertebral body density
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picture frame
paget's (cortex too prominent) osteoporosis (center too lucent) rugger jersey renal osteodystrophy ivory vertebral body mets paget's lymphoma (h>non h) infection |
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striated vertebral body
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multiple myeloma
hemnagioma osteoporosis paget's |
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vertebral body shape abnormality
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fish vertebra
sickle cell and thalassemias squared vertebra as, paget's, psoriasis, reiters |
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vertebral outgrowths
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syndesmophytes
AS flowing paraspinal ossification DISH small osetophytes djd spondylosis deformans large osteophytes psoriasis (common) reiters (uncommon) |
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posterior spinal fusion
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congenital (klippel feil)
surgical fusion arthritides JRA AS psoriatic arthritis reiters |
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vertebral body lesion
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mets
myeloma lymphoma eg gct hemangioma sarcomas (rare) |
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anterior vertebral body lesions
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lymphoma
myeloma Ewing's mets hemangioma EG Gct |
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posterior vertebral body lesions
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osteoid osteoma
osteoblastoma ABC |
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solitary vertebral lesions
A HOG |
abc
hemangioma osteoblastoma/osteoid osteoma GCT |
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posterior vertebral scalloping
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increased intraspinal pressure
spinal canal tumors syrinx communicating hydrocephalus dural ectasia neurofibromatosis marfan's ehlers-danlos congenital achondroplasia mucopolysaccharidoses (morqio's, hunter's, hurler's) osteogenesis imperfecta (tarda form) bone resporption acromegaly |
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anterior vertebral scalloping
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aortic aneurysm
lymphadenopathy tb spondylitis delayed motor development |
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anterior vertebral body beak
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morquio's syndrome ( central beak, others inferior beak)
hurlers achondroplasia cretinism downs neuromuscular disease |
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platyspondyly
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diffuse
dwarf (thanatophoric, metatropic) osteogenisis imperfecta morquios spondyloepiphyseal dysplasia solidary or multifocal leukemia EG mets/myeloma sickle cell disease |
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protrusio acetabuli
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paget's
RA osteomalacia, rickets trauma marfan's AS idiopathic |
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bilateral symmetric sacroiliitis
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AS
enteropathic spondyloarthropathy psoriatic arthritis HPT DJD |
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bilateral asymmetric sacroilliitis
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reiters
psoriatic djd |
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unilateral sacroillitis
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infection
djd trauma RA |
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lytic lesions of the sacrum
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mets
chordoma plasmacytoma chondrosarcoma GCT |
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lytic lesion of the ilium
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fibrous dysplasia
ABC UBC hemophiliac pseudotumor malignant lesions mets plasmacytoma ewing's chondrosarcoma lymphoma |
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widened pubic symphysis
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congenital
bladder exstrophy epispadias cleidocranial dysplasias GU or Anorectal malf bone resorption/destruction pregnancy osteitis pubis infection mets HPT |
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erlenmeyer flask deformity
CHONG |
craniometaphyseal dysplasias
hemoglobinopathies osteopetrosis neimann-pick gauchers (often with AVN) other lead poisoning fibrous dysplasia osteochondromatosis enchondromatosis fibromatosis |
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gracile bones
NIMROD |
neurofibromatosis
immobilization or paralysis polio birth palsies congenital cns lesions muscular dystrophies RA (juvenile) osteogenisis imperfecta dysplasias (marfans, homocystinuria) |
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femoral head AVN
ASEPTIC LEG |
alcoholism
sickle cell exogenous steroids or RT pancreatitis trauma (fracture/disloc, SCFE) infection caisson disease legg-calve-perthes epiphyseal dysplasia gauchers |
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medial tibial spur
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osteochondroma
blounts turners posttraumatic |
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cortical lesion
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adamantinoma
NOF fibrous dysplasia EG mets |
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heel pad thickeing (>25 mm)
MAD COP |
myxedema
acromegaly dilantin callus obsesity peripheraly edema |
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lytic lesion of finger
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enchondroma
solitary or multiple glomus tumor ( close to nail, pain) foreign body reaction epidermoid inclusion cyst (trauma hx) mets (lung, breast) sarcoidosis infection erosive arthropathy |
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radial hypoplasia
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VACTERL
Fanconi anemia Holt-oram syndrome cornelia de lange syndrome thrombocytopenia-absent radius (TAR syndrome) |
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short 4th/5th metacarpals
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pseudohypoparathyroidism
pseudopseudohypoparathyroidism idiopathic chromosomal anomalies (turners klinefelters) basal cell nevus syndrome |
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madelung's deformity
premature fusion of the ulnar aspect of radial epiphysis results in -ulnar angulation of distal radius -decreased carpal angle -dorsal subluxation of ulna -unilateral or bilateral HIT DOC |
hurlers
infection trauma dyschondrosteosis (Leri-weil syndrome) osteochondromatosis chromosomal XO (turners) |
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missing distal clavicle
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erosion RA
HPT postraumatic osteolysis infection mets/myeloma gorham syndrome absence cleidocranial dysplasia pyknodysostosis |
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high riding shoulder
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RA
CPPD rotator cuff tear |
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soft tissue calcification
TIC MTV |
tumor
tumoral calcinosis synovial osteochondromatosis soft tissue tumor (sarcoma, hemangioma, lipoma) inflammation/infection dermatomyositis scleroderma parasites leprosy pancreatitis (fat necrosis) myonecrosis bursitis/tendinitis congenital ehlers danlos myositis ossificans progressive metabolic hpt 1 or 2ndary metastatic calcification cppd calcium hydroxyapatite deposition trauma myositis ossificans burn injury hematoma vascular calcifcation |
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soft tissue masses
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tumor
malignant fibrous histiocytoma fatty tumors-lipoma, liposarcoma, fibromatoses vascualr tumors-hemangioma nerve tumors-schwannoma, neurofibroma mets burns hematoma muscle: rhabdomyosarcoma, leiomyosarcoma other myositis ossificans abscess hematoma aneurysm |
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osteogenic primary bone tumor
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benign
osteoma osteoid osteoma osteoblastoma malignant osteosarcoma |
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chondrogenic
|
benign
enchondroma chondroblastoma osteochondroma chondromyxoid fibroma malignant chondrosarcoma |
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fibrogenic
|
benign
fibrous cortical defect nof ossifying fibroma (sissons) desmoplastic fibroma fibrous dysplasia malignant mfh fibrosarcoma |
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bone marrow
|
benign
EG malignant ewings myeloma lymphoma leukemia |
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other
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benign
simple bone cyst abc intraosseous ganglion lintraosseous lipoma GCT brown tumor pseudotumor malignant adamantinoma chordoma malignant GCT |
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vascular
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benign
hemangioma lymphangioma angiomatosis malignant hemangioendothelioma hemangiopericytoma angiosarcoma |
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evaluating bone tumors
|
discriminators
patient age location patern of bone destruction tumor matrix tumor element |
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bone tumors by age: 1-15 years
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LCH
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bone tumors by age: 5-30 years
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osteosarcoma
ewing's sarcoma nof/fcd solitary bone cyst aneurysmal bone cyst fibrous dysplasia chondroblastoma |
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bone tumors by age: 20-50
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GCT
fibrosarcoma (>30) chondrosarcoma (>30) mets (>40) myeloma (>40) |
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lesions by location
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diaphysis-ie ewings
metaphysis-nof, osteochondroma, osteosarcoma, chondrosarcoma, fibrosarcoma epiphysis-subchondral cyst, chondroblastoma, GCT |
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bone destruction
|
aggressive lesions:
permeative or moth eaten, wide zone of transition, nonsclerotic margin nonaggressive lesions: well-defined border, narrow zone of transition, sclerotic |
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tumor matrix
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osteoid-ivory, fluffy, cloud like
chondroid-arcs/rings, punctate, stippled ground glass-hazy, fibrous dysplasia |
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tumor extent
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mono-ostotic
polyo-stotic |
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multiple lytic lesions of bone
FEEMHI |
fibrous dysplasia
EG enchondroma mets/myeloma hyperparathyroidism infection |
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osteoblastic lesions
|
benign
enostosis osteoid osteoma osteoblastoma malignant osteosarcoma |
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enostosis
|
slcerotic lesion in cancellous bone
spiculated margins giant>2 cm ddx blast met-prostate, breast, GU bone scan negative |
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osteopoikilosis
|
multiple bone islands
epiphyses and metaphyses clinically insignificant-diff from mets |
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osteoid osteoma
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nidus < 1.5 cm
w/ w/o central calcification surrounded by dense reactive bone pain, worse at night, relieved by aspirin ddx brodies abscess |
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osteoblastoma
|
nidus >1.5 cm
histology similar to osteoid osteoma targets typically posterior elements of spine and flat bones, unlike osteoid osteoma expansile, lytic and /or sclerotic |
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lytic lesion in posterior elements of spine
GO APE |
GCT
osteoblastoma ABC plasmacytoma EG |
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osteosarcoma
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2nd most common primary malignant bone tumor
metaphyses aggressive periostitis bulky soft tissue mass |
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telangiectatic osteosarcoma
|
lytic
aggressive minimal osteoid fluid-fluid levels |
|
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parosteal osteosarcoma
|
low grade
grood prognosis exophytic densely mineralized |
|
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periosteal osteosarcoma
|
extrinsic
saucer like area of cortical erosions |
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secondary osteosarcoma
|
5%
>60 yo risk factors, pagets, xrt |
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chondroid tumors
|
benign
enchondroma chondroblastoma osteochondroma malignant chondrosarcoma |
|
|
enchondroma
|
geographic lesion with narrow zone of transition with chondroid matrix unless in hand
look for fractures and chondrosarcoma maffucis (>20% malignant ts), olliers |
|
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chondroblastoma
|
geographic lytic lesion
on ct chondroid matriox with thin marginal sclerosis epiphysis |
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osteochondroma
|
metaphyseal
cortex and marrow continuity with host bone cartilage cap < 1.5 cm in adults multiple hereditary osteochondromas bilateral metaphyseal widening complications: neurovascular impingement, fracture, bursitis, malignant transformation into chondrosarcoma (>1.5 cm cartilage cap) |
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chondrosarcoma
|
3rd most common primary malignant tumor
pain >4cm in axial skeleton or flat bone cortical destruction (>2/3 cortical thickness destroyed) soft tissue mass bone scan activity increased |
|
|
fibrous lesions
|
benign
fibrous dysplasia NOF malignant fibrosarcoma |
|
|
fibrous dysplasia
|
developmental lesion
<30 yo sclerotic and/or lucent w/o periostitis ground glass long lesion in long bone shepards crook deformity monoostic (85%) or polyostotic (15%) mccune albright polyostotic FD cafe au lait spots precocious puberty intense bone scan |
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NOF/FCD
|
most common lesion
<30 yo NOF > 2cm and FCD < 2cm metaphyses eccentric, sclerotic margins, no breakthrough or soft tissue mass dont touch lesion |
|
|
fibrosarcoma and MFH
|
aggressive lysis, +/- bone sequestrum and wide zone of transition
soft tissue mass |
|
|
vascular tumors
|
benign tumors
hemangioma glomus tumor ABC malignant angiosarcoma |
|
|
hemangioma
|
benign proliferation of vascular channels
XR and CT-coarse calcification coarse trabeculation on CT high t1 on mri |
|
|
glomus tumor
|
neuromyo-arterial glomus
sharply marginate erosion distal phalynx |
|
|
ABC
|
reactive vascular process
primary-trauma (2/3) secondary-tumor (1/3) GCT, CB, OB expansile rim of intact cortex/periosteum well-defined |
|
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lesion with fluid-fluid levels
|
telangiectatic osteosarcoma
ABC GCT chondroblastoma osteoblastoma |
|
|
angiosarcoma
|
uncommon
like other sarcomas aggressive lytic lesion with soft tissue mass look for phleboliths |
|
|
myeloma
|
most common primary skeletal malignancy
malignant plasma cells replace normal marrow >40 red marrow (not distal skeleton) multiple small punched out lytic lesions |
|
|
plasmatcytoma
|
myeloma at single site
mm within 5 years |
|
|
benign miscellaneous bone tumors
|
SBC
LCH (eg) GCT |
|
|
SBC (UBC)
|
true cyst in kids
lytic narrow zone expansile metadiaphyseal central no periostitis unless fracture fallen fragment sign heal over time with sclerosis |
|
|
LCH (EG)
|
proliferation of histiocytes of unknown cause
s/sx-simulate infection (fever, wbc) px-depends on age and disease extent geographic lytic lesion non-sclerotic margin no matrix beveled edge (skull) vertebra plana |
|
|
localized LCH 70%
|
localized to bone
favorable px geographic lytic lesion non-sclerotic margin no matrix |
|
|
multifocal LCH 30%
|
multisystem involvement
younger-less favorable px |
|
|
GCT
|
skeletally mature
eccentric lytic lesion subarticular nonsclerotic with narrow transition zone |
|
|
miscellaneous malignant lesions
|
ewings
chordoma adamatinoma mets |
|
|
ewing sarcoma
|
second most common primary malignant tumor in kids
small round blue cell tumor aggressive diaphysis, long bones flat bones-aggressive, ill defined, no matrix age peak 10-15 yo |
|
|
chordoma
|
low grade from notochord remannts
locally aggressive soft tissue mass sacrum > clivus > vertebral body |
|
|
adamantinoma
|
rare
variable aggerssiveness low grade malignancy bubbly eccetric lesion in tibial midshaft |
|
|
mets
|
lytic
lung kidney breast blastic prostate breast bladder |
|
|
volar plate fracture
|
>35-40% of articulating surface->surgical repair
|
|
|
gamekeepers thumb
|
usually skiing, rabbit handlers
involves ulnar collateral ligament don't stress yourself, let patient stress stenner lesion operative |
|
|
monteggia fracture
|
proximal ulnar fracture
proximal radial dislocation |
|
|
galleazzi fracture
|
distal radial fracture
distal ulnar dislocation |
|
|
essex lopresti fracture
|
fracture of the radial head
dislocation of distal radioulnar joint |
|
|
freidberg's infraction
|
avn of the second metatarsal head
long second metatarsal bone high heels |
|
|
fifth metatarsal fractures
|
avulsion of the tip-peroneus brevis tendon attaches, tx with hard boot
1 1/2 to 2 cm from articular surface->jones fractures, nonweightbearing |
|
|
calcaneal fractures classification
|
ct sanders classification
|
|
|
ankle fractures-supination adduction
|
1. fibular fracture at or below the joint line
2. vertical fracture through the medial malleolus |
|
|
ankle fractures-supination external rotation
|
1. angular fracture at the joint space at the fibular
2. ?? fibular fracture? 3. fracture of the posterior tibia 4. ??? medial malleolar fracture look up |
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|
ankle fractures-pronation abduction
|
1. medial malleolar fracture
2. ?disruption of tibiofibular ligament 3. comminution of high fibular fracture with communication and triangular fragment look up |
|
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ankle fractures-pronation external rotation
|
1. transverse fx of medial malleolus or deltoid ligament injury?
2. posterior tibia or disruption of the tibfib ligament 3. and high fibula-> ask for knee film 4. ???posterior tibia maissoneuve injury look up |
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lateral process talar fracture
|
seen in snowboarders
|
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pelvic injuries
|
look up
|
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|
open book pelvic fractures with widening of the pubic symphysis
|
high correlation with severe bleeding and death.
|
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|
key fractures from ucsf
|
48 skeletal trauma review
|
|
|
transverse acetabular fractures
|
separates iliac wing from obturator wing,
front to back fracture line |
|
|
anterior column acetabular fracture
|
disruption of the ileopectineal line separating acetabulum into front and back halfs
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peroneus brevis tendon tear
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dorsiflexion/inversion
longitudinal splits near lateral malleolus |
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segond fracture
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avulsion lateral tibial rim
avulsion posterior ITB/lateral capsule internal rotation, varus stress >95% acl tears 40-66% meniscal tears lat>med |
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spontaenous osteonecrosis aka SINK or SONC
|
spontaneous insufficiency fracture of the knee
acute onset of pain stress reaction of weight bearing surface of medial femoral condyle often associated with low bone mineral density and meniscal tear ddx ocd-closer to the notch of medial femoral condyle and in younger patients infarcts |
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tansient osteoporosis
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bone marrow edema syndrome of hip
m>f (third tri) unknown etiology...poss stress related self limited 2-9 mo osteopenia of hip without narrowing hot on bone scan edema and effusion on MRI |
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acetabular labrum tear
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hip pain, clicking, locking
predisposing conditions femoroacetabular impingement childhood hip dz ddx legg calve perthes trauma osteoarthritis idiopathic |
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femoroacetabular impingement-abnormal contact between prox femur and acetabular rim with repetive motion->labral tears, cartilage damage
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cam-type younger males
asphericity pincer type acetabular overcoverage |
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ulnocarpal impaction
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positive ulnar variance or long ulnar styloid
tfc degeneration and perforation cartilage disruption lunate and triquetrum sclerosis, cysts, erosions lt ligament tears |
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femoroacetabular impingement-abnormal contact between prox femur and acetabular rim with repetive motion->labral tears, cartilage damage
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cam-type younger males
asphericity pincer type acetabular overcoverage |
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ulnocarpal impaction
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positive ulnar variance or long ulnar styloid
tfc degeneration and perforation cartilage disruption lunate and triquetrum sclerosis, cysts, erosions lt ligament tears |
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rotator cuff tear
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tear from articular or bursal surface
may have fluid in SA-SD bursa muscle retraction atrophy fatty infiltration check condition of tendon edge frayed edges are debrided prior to repair |
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hill sachs lesion
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impaction fracture humeral head s/p anterior dislocation
top 2 cm of humeral head 75% recurrent dislocators large defects engage glenoid upon dislocation |
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bankart lesion
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detachment of anteroinferior labrum from inferior glenoid rim
disruption of scapular periosteal attachment more common in younger patients with instability |
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alpsa lesion
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anterior labroligamentous periosteal sleeve avulsion
intact scapular periosteum balled up labrum inferomedial to glenoid |
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perthes lesion
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avulsion of anterior inferior labrum
remains attached to scapular periosteum better seen with aber positioning |
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suprascapular nerve entrapment
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mixed motor and sensory nerve
originates from c4-c6 suprascapular notch branches to supraspinatus spinoglenoid notch branches to infraspinatus |
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gout
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ddx
infection sarcoid mets |
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synovial osteochondromatosis
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primary
synovial metaplasia monoarticular knee primary location 2/3 ossify tx with synovectomy secondary djd, avn, ocd tx primary problem |
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smooth pressure erosions
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pvns
synovial chondromatosis synovial hemangioma amyloid |
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erosive osteoarthritis
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middle aged women
symmetric pip, dip, 1st carpometacarpal joint |
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psoriatic arthritis
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normal mineralization
asymmetry sausage digit uniform joint space narrowing marginal erosions, dip, pip, carpals pencil-in cup deformity new bone formation adjacent to marginal erosions periosteal reaction enthesopathy normal mineralization |
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multicentric reticulohistiocytosis
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unknown etiology
arthritis and nontender soft tissue noduels dip erosions women>men 25% malignancy |
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gout
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asymmetric and sporadic
normal joint space normal mineralization tophi punched out erosions, carpometacarpo and pip, dip joints, away from joint overhanging edges bone destruction |
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rheumatoid arthritis
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location
carpus (ulnar styloid) mcp and pip joints erosions bare areas head of metacarpal more prominent on radial side no sclerosis or bone proliferation unless treated bilateral symmetric fusiform soft tissue swelling early osteopenia fusiform soft tissue swelling effusion advanced uniform narrowing erosions malalignment subluxation |
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cppd
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affects mcp, radiocarpal joints
less commonly pip and dip mild erosions, mostly osteophytes subchondral cysts maybe large chondrocalcinosis present but not always drooping osteophytes of radial carpal heads think hemachromatosis, hyperparathyroidism, renal osteodystrophy associated with SLAC wrist scapholunate advanced collapse widening of scapholunate articulation capitate migration sl tears also could be assoc with rheumatoid and drillers cppd of the hip axial narrowing +/- osteophytes cysts common cppd of other joitns >50 yo cppd knee wrapped patella with patellofemoral joint and with saucerization of the distal femur on lateral meniscal calcification |
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hemachromatosis
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mcp narrowing
drooping osteophytes osteopenia systemic darker skin cirrhosis |
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juvenile idiopathic arthropathy
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soft tissue swelling
osteopenia periosteal reaction overgrown epiphyses premature epiphyseal fusion narrrowing, erosions, and fusion later |
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joint infection
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unilateral
diffuse narrowing osteopenia teardrop distance maybe increased bulging fat planes |
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pigmented villonodular synovitis
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monoarticular
knee (80%) 20-50 yo hemosiderin lack of joint space narrowing subchondral cysts treated with synovectomy if diffuse ddx on mri hemophilia |
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hemophilia
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chronic hemarthrosis and intraosseous hemorrhage
osteopenia increased density in effusions enlarged epiphyses subchondral cysts secondary oa-sporadic and asymmetric prominent intercondylar notch of knee, squaring of the patella, involvement of medial and lateral compartments ddx jia |
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reactive arthritis
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calcaneal erosions
also maybe seen with other spondyloarthropathies retrocalcaneal bursitis ip joint great toe-osteitis |
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neuropathy
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5 d's
density debris disorganization dislocation degeneration |
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neuroarthropathy
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atrophic form
pseudosurgical aunt minnie syringomyelia in shoulder |
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high riding shoulder in the setting of arthropathy
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cppd
ra |
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rheumatoid arthritis of the foot
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location
tarsals (can fuse) tarsometatarsal mtp pip characteristics subluxation hallux valgus erosions med 1-4 mt head lateral 5 mt head bare areas |
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rheumatoid arthritis of the spine
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atlantoaxial subluxation >3mm
basilar invagination subaxial vertebral body subluxation erosion odontoid facet joints joints of luschka |
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ankylosing spondylitis
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si joints
bilateral symmetric spine squaring shiny corners syndesmophytes vertical, marginal on both sides of the disc ankylosis peripheral joints hips, knees, ankles, shoulders bone proliferation |
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psoriatic and reactive arthritis
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sacroiliitis
bilateral, asymmetric paravertebral ossification non marginal non vertical coarse one side of disc |
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HADD
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hydroxyapatite deposition disease
deposit in tendons, ligaments, bursae, soft tissues fluffy, amorphous (vs linear or punctate-cppd) inflammatory response soft tissue edema bone erosion difficult to visualize on mr |
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olecranon bursitis assoc with arthropathy
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gout
ra |
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avn staging system (ficat)
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stage 1
normal xr abnl mri or bs-line of demarcation between necrotic and viable bone stage 2-trabecular changes patchy sclerosis and lucency stage 3 segmental flattening or collapse stage 4 secondary oa of join tx early-stage 1 and 2, core decompresion stage 4-total joint replacement |
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slap tear
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high signal in superior labrum perpendicular to to superior recess
linear high signal posterior to the anchor |
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sarcoidosis
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lace-like trabecular pattern
fusiform soft tissue swelling patchy sclerosis |
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OPLL
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idiopathic
men peaks in 50s cspine>95% asx versus myelopathy assoc with dish |
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DISH
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idiopathic
older men flowing ossification over 4 continuous levels disk height normal, excludes ddd si joints are normal |
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neurofibromatosis
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mesodermal dysplasia
bone involvement >=80% tibia bowing pathologic fracture pseudarthrosis spine scoliosis +/- kyphosis posterior scalloping ddx marfans, ehlers danlos dural ectasia mass anterior scalloping ddx mesodermal dysplasia lad aortic aneurysm tb |
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intarvertebral vacuum cleft-collapsed vertebral body with lucency
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osteonecrosis +/- steroids
delayed post-traumatic collapse kummell disease makes unlikely infection malignancy |
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vertebral plana
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eg
osteoporosis-steroids tumor-mets, myeloma trauma |
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gaucher's disease
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marrow infiltration
erlenmeyer flask deformity osteonecrosis |
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paget's disease
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osteitis deformans
chronic skeletal dz disorders bone remodeling unknown cause, probably paramyxovirus 3 phases 1 lytic-osteoclastic well defined lysis nonsclerotic margins travels down bone-> flame shaped blade of grass 2. mixed trabecular coarsening osseous expansion cortical thickening 3. sclerotic-osteoblastic ivory vert body ddx osteoblastic met lymphoma picture frame vertebral body osteoporosis circumscripta cotton wool complications 1. bone weakening bowing osseous expansion cortical thickening insufficiency stress fracture 2. neurologic compromisee spinal stenosis 3. sarcomatous transformation |
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diffuse periostitis
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chronic venous stasis
caffey disease thryoid acropachy hypertrophic osteoarthropathy primary-familial, idiopathic mostly secondary to pulmonary-bronchogenic ca pleural-mesothelioma cardiac-congenital heart disease abd-ibd |
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arthritis w/ osteoporosis
|
ra
jca arthritis-disuse or steroids septic arthritis +/- osteo |
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arthritis without osteoporosis
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seronegative-psoriatic arthritis
gout synovial osteochondromatosis pvns |
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arthritis with preservation of joint space
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synovial osteochondromatosis
pvns tb-phemisters triad |
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acute pyogenic osteomyelitis and arthritis
|
radiographs
acute 24-48 hours soft tissue swelling, air loss of fat plans 7-10 days intramedullary destrxn 2-4 weeks cortical destruction endosteal scalloping periosteal reaction' 6-8 weeks sequestrum involucrum |
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sequestrum
|
necrotic bone isolated by granulation tissue
can persist, reabsorb, or extrude through sinus tract often multiple ddx osteoid osteoma mfh mets lymphoma |
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involucrum
|
reactive new bone produced beneath elevated periosteum by infection
more common in younger patients |
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bordie's abscess
|
form of subacute osteomyelitis
geographic lytic lesion may contain sequestrum metaphyseal cortical or medullary sinus tract may cross growth plate |
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sclerosing osteomyelitis
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osteomyelitis of garre
subacute form of osteomyelitis with dense sclerosis ddx lymphoma mets |
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chronic osteomyelitis
|
mixed lytic and sclerotic lesions with thickened cortex
deformity reactivation of acute osteomyeltiis new lytic destruction or periosteal reaction |
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|
septic arthritis
|
monoarticular
joint effusion increased teardrop distance >1mm from other side soft tissue swelling osteopenia uniform joint space narrowing erosion mri joint effusion soft tissue edema synovial enhancement usually uniform jt narrow erosions bone marrow edema |
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pyogenic osteomyeltiis spine
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irregular vertebral enplate
due to hematogenous spread to vessels near vertebral body endplate disc space narrowing paraspinal mass vertebral collapse fusion MRI decreased si on t1 increased si on t2 fluid in intervertebral space gad enhancement unless abscess |
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sickle cell osteo
|
salmonella typical
staph common diaphyseal infection frequent in areas of infarction |
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|
diabetic foot infection
|
mri preferred
demonstrates infection extent normal marrow or low s1 on t2 excludes osteo abnormal marrow can be tricky neuropathic foot mimics insufficiency fracture reactive edema in cellulitis |
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|
osteomyelitis complications
|
joint involvement
leg-length discrepancy slipped epiphysis avn pathologic fracture squamous cell carcinoma with chronic osteo with 3 year interval |
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|
chronic recurrent multifocal osteomyelitis (CRMO or SAPHO)
|
subacute and chronic osteo of unknown cause
multiple and symmetric bone invovlement predilection for lower extremity metaphyses, tubular bones and medial ends of clavicles in pediatric patients osteolysis with intense sclerosis does not respond to antibiotic therapy synovitis, acne, pustulosis, hyperostosis, osteitis ddx fibrous dysplasia pagets disease |
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tb osteomyelitis
|
1-3% skeletal involvement
hematogenous spread lung (active in 50%) gu tract 3-24 months to appear on radiographs cold abscess sequestra uncommon |
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|
spinal tb
|
most common osseous site
50% of skeletal tb at spine starts anterior adjacent to the endplate endplate erosion anterior scalloping due to extension along ant long ligament multiple segments subacute extensive abcesses maybe epidural vertebral destruction and disc invovlement relatively late ddx lymphoma-can leave cortex intact, diffuse enhancing paraspinal soft tissue mass |
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tb dactylitis
|
"spina ventosa"
infants and young children often multifocal sts, periostitis, bone involvement, fracture ddx jra sickle cell other infections |
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|
syphillis
|
congenital or acquired
wimbergers sign symmetric lesions, medial metaphysis proximal tibia periostitis saber shin deformity-anterior bowing of tibia, later stages gummas-sterile bones abscesses of tertiary syphillis |
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|
fungal infections
|
coccidiomycosis
punched out lytic lesions abscess can mimic bone or soft tissue tumor blastomycosis abcess and fistulas cryptococcosis actinomycosis lung and jaw maduramycosis madura foot |
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|
rubella
|
transmitted from mother to fetus in first trimester
radiographs medial metaphyseal beaking irregular metaphysis with celery stalking ddx toxoplasmosis cmv |
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|
pyomyositis
|
immunosuppressed patients
can have abscess ddx trauma strain contusion myositis ossificans infarction |
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|
reflux sympathetic dystrophy
|
profound and periarticular osteopenia
bone scan diffuse periarticular uptake 3rd phase most accurate |
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|
rickets
|
bowing of long bones
metaphysis and physis widening and fraying, cupping, and slipping knee wrist costochondral junction-rachitic rosary |
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|
rickets and osteomalacia
|
abnormal mineralization
growth plate (rickets) mature bone (osteomalacia) vitamin deficiency liver or kidney disease (2 hydroxylations to be active) gi malabsorption dietary deficiency generalized demineralization coarse trabeculae |
|
|
osteomalacia
|
looser's zone "pseudofracture"
unmineralized osteoid linear lucency traverse part of bone common sites proximal femur lateral sapula tibia |
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|
hyperparathyroidism
|
subperiosteal resoprtion-radial aspect of phalanges, medial aspect of proximal tibia,
trabecular resorption-salt and pepper skull subligamentous resorptions-undersurface of clavicle subchondral resorption-distal clavicle, si joints brown tumor primary-autonomous hyperfuctnion adenoma>hyperplasia secondary chronic renal failure, malabsorption tertiary form 1 bone resorption generalized osteopenia brown tumors subperiosteal, trabecular, subligamentous, subchondral |
|
|
renal osteodystrophy
|
ruggery jersey spine-bands of endplate sclerosis
due to secondary hyperparathyroidism and osteomalacia in renal failure get bone resorption, subperiosteal, trabecular, subligamentous, subchondral osteomalacia-coarse and indistinct trabeculae dense bones brown tumors soft tissue calcifciation common vascular periarticular tumor calcinosis dystrophic calcification |
|
|
hypoparathyroidism
|
deficiency of pth production
usually post-surgical->hypocalcemia xr osteosclerosis soft tissue calcifications subcutaneous basal ganglia |
|
|
pseudo and pseudo pseudo hypoparathyroidism
|
characteristic somatotype
obese and short stature brachydactyly soft tissue calcifications and short metacarpals |
|
|
hypothyroidism
|
delayed skeletal maturation
wormian bones epiphyseal dysgenesis stippled, coned, fragmented scfe |
|
|
hyperthyroidism
|
kids
accelerated skeletal maturation adults osteoporosis |
|
|
thyroid acropachy
|
clinical
<1% of hyperthyroidism patients after tx (usually no longer hyperthyroid) fluffy periostitis soft tissue swelling |
|
|
acromegaly
|
kids
gigantism advanced height and bone age adults acromegaly bone and soft tissue overgrowth in acral regions thickened heel pad enthesophytes distal phalanx enlarged with spade like tufts large frontal sinus large sella turcica |
|
|
scurvy
|
hypovitaminosis c
abnormal collagen decreased bone production->osteoporosis hemorrhage->subperiosteal relative sclerosis at epiphysis wimburgers sign, rim of sclerosis surrounding osteoporosis corner fractures metaphysis (white line of frankel) ddx torch syphillis neuroblastoma medication methotrexate |
|
|
tarsal sinus syndrome
|
trauma, mostly inversion sprain
inflammatory arthritis check lateral ligaments, ptt can't make diagnosis in acute ankle MRI darkened out on T1 high intensity on T1 |
|
|
chordoma
|
ddx
chondrosarcoma giant cell tumor plasmacytoma mets from vertebral body bone destruction and anterior soft tissue mass |
|
|
metatarsal stress fracture
|
may not seen fracture line
soft tissue edema can prevail |
|
|
capitellar ocd
|
unstable if surrounded by t2 signal, contrast, or cystic signal
complete ossification of capitellum, loose bodies ddx-panners=osteochondrosis (osteonecrosis)- affects ages 5-11 yo, ossification of capitellum incomplete |
|
|
discoid meniscus
|
singal does not have to extend to the edge to be a tear
not all are complete |
|
|
achilles partial tear/tendinopathy
|
rounded tendon
loss of anterior concavity |
|
|
giant cell tumor
|
ddx
chondroblastoma chondrosarcoma, mets, multiple myeloma post traumatic cyst geode |
|
|
bucket handle meniscal tear
|
unstable vertical tear
pain, locking double delta sign |
|
|
benign myxoma
|
ddx
hematoma abscess neurofibroma enhancement variable benign vs malignant on mri-overlap exists favoring malignant large >5cm increased heterogeneity deep |
|
|
benign compression deformity of the spine
|
osteoporotic vs pathologic
both show abnormal t1 signal in first 3-6 months retropulsion suggests benign fracture preservation of some marrow suggests benign fracture |
|
|
enchondroma vs chondrosarcoma
|
ddx
low grade chondrosarcoma hands and feet-chondrosarcomas rare spine and pelvis with soft tissue mass=sarcoma-enchondromas rare here f/u in absence of new or increasing symptoms |
|
|
multiple myeloma imaging
|
three patterns
focal most common diffuse variegated |
|
|
polycythemia vera
|
ddx
reconversion infiltration-myeloproliferative d/o depletion edema ischemia normal marrow brighter than muscle on t1 and than disc in spine |
